A Hospital Billed Me $18,339 for an MRI, So I Tried to Make Prices Public

Three months after I had an MRI, the hospital’s bill showed up: $18,339. Even with insurance, I had to pay $5,413 of it myself. Booked through the company I started later, the same scan would have cost about $350. The hospital charged more than 50 times that.

That bill is why I went on to start Tripment Health, a company I ran until I closed it in April 2024. I want to explain why American patients rarely know the price in advance, what happened when I tried to show prices up front, and what to do before you agree to anything.

Why you rarely know the price up front

In any normal business you know the price, sellers compete for you, and you get to choose. In my experience, American medicine usually gives you none of the three. Hospitals have had to post their prices online since 2021, yet if you have insurance, you almost never know what you’ll owe until the bill comes. And because you don’t know it up front, the bill that shows up months later can wipe you out. As of 2021, about 14 million American adults owed more than $1,000 in medical debt.

The pitch is that if you have insurance, you’re protected. In my experience, it protects you a lot less than people think. In a national study of people who filed for bankruptcy in 2007, three out of four whose bankruptcies were tied to medical costs had health insurance. The way I see it, your insurance company is a middleman: it pushes the price up, makes the whole system more complicated and earns its money off you.

Then there’s how doctors get paid. More than half of what Americans spend on care is still paid per service: the more tests and procedures, the bigger the payment. In my view, a lot of what makes care so expensive is the way it gets priced, billed and paid for, rather than the treatment itself.

Congress did pass a law against surprise bills. The No Surprises Act was signed in December 2020 and took effect in January 2022. It’s stopped some of these bills, but it does nothing about what a hospital in your own network charges.

Why does it work this way? There’s no single buyer big enough to push prices down, because every insurer negotiates on its own. By one estimate, about a third of what the country spends on health care goes to administration. In Canada the share is half that. Most drug prices have no cap at all, and Medicare didn’t start paying negotiated prices on the first ten drugs until 2026. Health care in America is a business of more than $4 trillion a year, close to a fifth of the economy. The latest official figure, for 2024, is $5.3 trillion. The health care and social assistance sector employs more people than any other. I don’t think the big insurers and hospital systems are in any hurry to make it simpler.

What I built to show the price first

I started Tripment in 2020. The idea was simple: show the price before the patient books, and let the clinics compete on price. My view was that where there’s no competition, quality drops and prices climb, and medicine had almost none. I was naive enough to think I could fix that myself. Our motto was “Upfront prices, no surprises.”

We showed real prices for different kinds of MRI scans and worked with a lot of clinics. An MRI on the platform usually cost $300 to $500, depending on the scan. At hospitals the same scan often cost many times more, as my own bill showed. The clinics were the same ones that bill insurance companies, with the same machines and the same doctors. From what I saw, patients who paid up front through us often paid a small fraction of the insured price.

We sold lab tests through Quest Diagnostics and Labcorp, the two biggest lab chains in the country. We bought at wholesale, and by my comparison our prices came in below what the labs charged patients directly. You paid online, got a QR code and showed it at the lab. You didn’t have to call anyone, and you didn’t need an order from your own doctor, because one of our physicians ordered the tests for you.

Patients paid before the appointment, by card or bank transfer, and nobody ever got a bill afterward. In early 2022 SimonMed, a large radiology group based in Arizona, added more than 160 of its imaging centers in 11 states to our platform. By 2024 more than 10,000 patients had used the platform.

In December 2021, a competitor called MDsave sued Tripment and two other companies that showed prices up front, over patents and trademarks. We denied the claims and filed our own suit in Delaware. In 2022 both sides agreed to drop their claims against each other.

$650 for two minutes at the dentist

Here’s what paying blind looks like in real life. I split my time between New York and Chicago, and my regular dentist is in Chicago. I was in New York, a day or two from flying to Europe, when I chipped a tooth. Only a tiny piece broke off. It felt a little sharp, but it was nothing serious. I only wanted the edge smoothed down so I could travel, and my dentist in Chicago would handle the rest when I got back two weeks later.

Someone had once introduced me to a dentist in Manhattan, so I called his office, and they told me to come in. At the front desk I explained what I needed and asked how much it would cost. The receptionist said she couldn’t tell me, and that I’d find out once I was in the chair. The assistant who came in said they had to take an X-ray first. I asked if we could skip it, and she said no.

The dentist looked at the X-ray and filed down the edge. It took him about two minutes. The bill came to $650, and nobody gave me a number before the work was done. I could have refused to pay, but I didn’t. I haven’t been back since.

Around the same time my brother chipped a tooth in Portugal. He walked into a dentist’s office without an appointment and paid 35 euros for the same couple of minutes.

What I tell people now

When patients can see the price, they choose the cheaper place, and prices come down. I saw it happen on my own platform. In one insurer’s program that showed members MRI prices up front, the average scan came out $220 cheaper, almost 19%.

The real question is why we agree to pay without knowing the price.

So ask what it costs before anyone does anything to you, whether it’s a scan, a lab test or two minutes of filing down a tooth. If nobody will give you a number, you’re agreeing to pay blind, and that’s exactly what I did at the dentist. If you don’t have insurance, or you’re not using it, you have a right to a written estimate in advance. You’ll need that estimate to use the federal dispute process if the bill comes in well above it.

Have you ever gotten a medical bill you didn’t see coming? Tell me about it in the comments.

Originally published as a video on my YouTube channel on 27 April 2026. Watch on YouTube