I was charged $6000 for literally walking into the ER of a hospital in 2022 when I had covid and was having trouble breathing. This did not include the 20 mins of tests they ran for me before telling me I was fine and booting me out within the hour, those were billed seperately. Literally just the cost of using the ER was $6000 (this was the adjusted price after insurance), in addition to anything else. As you can tell from this comment, I'm still mad about it.

One of the most important provisions of the ACA was the caps on the "medical loss ratio", the percent of insurance premiums paid out for medical care. The act required insurance plans to maintain a MLR no lower than (IIRC) 70-80%. Before then, plans (eg, targeting college kids) had MLRs as low as 10%.

(For comparison, Medicare/Medicaid has something like a 95% MLR, because it has low administrative overhead and isn't returning a profit to shareholders.)

17x upcharges, if they were extracted at the insurance level instead of the hospital level, would be the equivalent of a MLR of around 6%.

This. I want to know which places to avoid at all costs.