Companies often struggle with controlling their cloud costs due to factors such as the pay-per-use model, lack of visibility into expenses, and decentralized decision-making. Cloud cost management involves monitoring, reporting, allocation, budgeting, and forecasting cloud costs. However, it doesn't guarantee savings unless combined with automated optimization. Automated optimization can help manage instance rightsizing, autoscaling instances, managing spot instance interruptions, and more. Companies should consider using both cloud spend management and optimization strategies to keep costs under control effectively.