Well, if providers can't be expected to know, then certainly the burden shouldn't be shifted onto the patient. Ideally the whole thing would be overhauled with a focus on medical outcomes and not profits.

But ideally, the system would deal with the pathway/guideline issue on a provider level and eventually drop Doctors/facilities from their network if they have a demonstrable track record of inappropriate clinical practices. Not shift the burden upon the individual. In particular, not drop it on the individual after service has been provided.