Something to consider, though it doesn't directly relate to max out of pocket costs, is that healthcare providers fail to collect the majority of out of pocket

Something to consider, though it doesn't directly relate to max out of pocket costs, is that healthcare providers fail to collect the majority of out of pocket responsibility from patients. The cost to collect and the collection rates themselves are abysmal and the increase in deductibles has amplified the problem to the point that many hospitals are closing due to patients' inability to pay their bills. Consider the percent of Americans who don't have ready access to $5000 (or even $500) for an unexpected medical event that causes them to hit their deductible. I work in patient payment technology and this is an all too common situation that providers are forced to accommodate.