You didn't miss much.

No. Because I, at least, am aware of my limitations of knowledge. I did not spend eight years of adult education and a grueling internship to become a medical professional, and I am not going to tell them how much they have to charge for their services. Not being an administrator of such businesses, I also have no way of knowing what it costs to bring medical equipment and supplies to a remote island chain. Hawaii is infamous for the high costs of everything else. The laws of economics and supply and demand, and the costs of transportation are not suspended because it's for something you really, really, REALLY want.

Who is doing that?

How do you know it was ridiculous? What services were provided? What costs did they incur? We know nothing. We know that the people unhappy with the bill claim it was too much.

They are dictated by the same government that is currently involved in a highly controversial attempt to regulate and interfere to an unprecedented and incredible degree in the insurance industry. Government regulations that protect health insurance companies and force them to cover cheaply or for free, every odd ailment or situation that comes along with a sob story are what drives those prices up. You want to slash the prices of medical care in this country? Outlaw insurance. That way the insurance will all be underground and black market. The government will not be able to force employers to insure all their employees. The insurance companies will not require massive overhead and administrative costs to medical care providers for reimbursement. If medical insurance is outlawed, they will not be able to pass laws forcing companies to cover this that and everything else, which drives the prices for everything else through the roof. Medical providers end up overcharging to compensate for all the freeloaders, and for the insurance companies that don't pay out (particularly the government-run ones like Medicare). This "damn the insurance companies, make them pay" mentality is exactly why hospitals overcharge, such as double digit prices for a single aspirin pill, because most of their payment comes from insurance companies, that will either stiff them, thanks to regulatory loopholes, or else pay up and pass the costs onto their paying customers. The various mandates that force people or companies to buy medical insurance enable to the insurance providers to be less responsive to their customer's needs. Notice how many more commercials there are on TV for every other kind of insurance? Because no one publishes articles whining about this guy's or that woman's car or home repair costs, so no one forces insurers to provide that, or imposes responsibilities to cover certain claims on those companies. Because people are free to pick and choose, to buy coverage only for what they need or want. There is no government program like Medicare or Medicaid for other areas of insurance activity. Customers have the power to a much greater degree than they do over health insurance companies, and so they must pander to the general public.

The reality of the situation is that people feel entitled to medical care, feel justified in demanding more for less, someone has to foot the bill, and insurance companies stepped into the gap, and leveraged that position of power - providing what people want - into driving up the prices, to force more customers into their market and take in more money.

Who says the expectations were reasonable? Sure the couple says that, but a couple that was being UNreasonable would say the same thing. I find it rather unreasonable to expect a short-term traveler's insurance policy should cover nearly a million dollars in expenses.