It's time entirely likely they never actually paid anything out of their own pocket. Situations like this are awfully common, so hospitals pretty easily mark a bill as in legal dispute and move on while it gets sorted.

Part of the horrible cycle is that bills are high to cover costs while bills are disputed, which makes them more likely to be disputed.

That sucks. I mean, I’m glad it eventually worked out, but that’s a lot of BS for them to put up with because insurance didn’t want to pay.

Then the insurance is incorrect for the situation. IOW if you know the US charges stupid prices then insurance should be commensurate. Or not go to the US. Not blaming the people, just an insurance company that is inept.

Apparently if you ask for an itemised bill (Which they have no right to refuse) they tend to lower the price because they can't actually justify the random numbers they came up with.