There's a lot of rant in this post which I'm going to leave to the side, because I have no idea what happened between you and that physician / billing agency / insurance. "In office surgery" may mean you got scoped, but I'm not an ENT, and I'm not going to speculate on what happened.

First point: If you're willing to pay cash and bypass the insurance / CPT / ICD10 / RVU rigamarole, I'd like to direct you to any number of concierge physicians who will gladly take your money, provide you their cell phone, and give you 24/7 availability. Simply Google "concierge physician san diego", and you'll have your pick of physicians from UCSD or Scripps or other great places in SD.

Second Point: You're conflating a whole lot of stuff. Your insurance doesn't pay us enough to do the whole "personal estimated bill". That's the patient's responsibility. You and your insurance company are the only people who know the status of about 10+ variables which will affect your out-of-pocket-cost. What's your deductible's status: Have you exceeded it? What's your out of pocket max for the year? Do you have a copay or coinsurance for ambulatory services vs hospital provided services? Are we in-network with your variant insurance company's policy? There's no API for us to query all this information from Aetna/BCBS/Humana/et al, and given how insurance companies LOVE to put up barriers to care via prior authorizations, that API is never happening unless mandated by federal law or built by yet ANOTHER company.

>The reality is that the provider is like a programmer who builds what I discussed with her to build only that I get a $10k bill AFTER THE FACT without having a say in whether I am OK with it or not and she just went ahead and did the project for me without even asking me if I wanted her to do it.

This is a false equivalence. The medical equivalent to this scenario would be calling and speaking to a physician on the phone about whether you even need an appointment and then receiving a bill for a consultation with lab testing. Our taking an interview with you, reviewing outside notes/labs/imaging, doing a physical examination, and providing our expert opinion IS our deliverable product, NOT the procedure and definitely NOT the medication we prescribe. You wouldn't engage a business consultant or a lawyer for advice and not expect to pay for their time? Why is it different with physicians?

The "I WANT AN ESTIMATE UP FRONT" request is fine for some areas of care, but if it were up to me, I'd simply give you my charge-master-highest-rate and say "I don't know what your particular insurance company has negotiated and which contract will be in effect at the time of bill submission, so the resulting charge may be lower than this. It will not be higher". For example, I'm in Radiology, so my billing is different. My deliverable is not an in-person consultation, rather a diagnostic imaging examination, interpreted to the best of my expert opinion. I can provide a concrete, encapsulated, whole estimate of charges for both the technical and professional fees, and that estimate will be the maximum I charge all 3rd party payers.

I agree with the answer provided by Quora. You're asking someone to do ALL the work, before you even decide to pay them. This is the equivalent of asking a lawyer to evaluate a contract and then offer you a per-paragraph rate of evaluation based on the projected complexity of each section, before you even then decide to pay them a dime. That estimate is difficult to perform without going ahead and just doing the work. If you're going to play that game in medicine, just pay the physician hourly like in law in 15-minute increments or get a concierge doc.