So, at the absolute most charitable interpretation, this punishes patients for having a slow surgical staff or for a surgery having complications. Like most insurance things, punishing the patient for shit completely outside of their control.

On top of this, best outcome of this (for doctors to try and ensure their patients don't need to decide between potential financial ruin or surgery) would be for all surgical departments to wildly inflate their surgery times so they can't ever be over estimate. This will significantly reduce the amount of surgeries able to be completed per day, and hike up the price even more as they have to bill for more time.

The only possible justification for this is attempting to find another place to lower financial costs to the insurance company at any "cost". I miss when these people had enough shame to not go this mask off.