Anna Hourihan, a postpartum doula in Boston, is facing a pile of bills from student loans, a mortgage payment and credit cards. She also owes “a few thousand dollars” in medical bills from copays, deductibles and coinsurance. While not record breaking, her medical debt troubles her. She’s often uncertain of what her insurance chooses to cover, which causes her to hesitate before seeking further care.

Unlike debt from student loans or credit cards, debt from medical bills is often hard to anticipate. Patients typically do not know the cost of care upfront and may not have an opportunity to compare costs. Even former U.S. Surgeon General Jerome Adams was surprised by a recent bill he received after being treated for dehydration, citing a “broken system.” Bills are often delivered months after receiving care, which makes financial planning a challenge. Hospitals are expected to provide accessible information upfront via the Hospital Price Transparency rule, though this is not done consistently.

“Our healthcare system is flawed as medical services are paid at different rates depending on your insurance,” says Dr. Scott Weiner, health services researcher at Brigham and Women’s Hospital. And even if you look at a hospital’s website for transparent pricing it may be incomplete or not user friendly. Securing accurate costs of care is not as simple as asking a mechanic the cost of an oil change and getting a price point that’s guaranteed. “There’s also the issue that patients do not always know what they need. And doctors and nurses do not always know associated costs.”.