Published in JAMA, this editorial describes the fundamental importance of knowing the costs of patient care before you can reduce the costs. Clarity about the drivers of cost can guide cost-reduction strategies. The authors describe the significant financial and social costs of the current billing and administrative processes to patients and their families and includes four major developments actively transforming the health care landscape that can create opportunities to solve the current billing and insurance conundrum: (1) evolving alternative payment models, (2) increasing mergers among health insurers and between insurers and health systems, (3) EHR implementation, and (4) rising consumer payments.