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Not always true. That OOP max often only applies to providers who are considered in-network for your insurance plan. Oftentimes, there's no way to guarantee tha
by benmaraschino 7y ago
Not always true. That OOP max often only applies to providers who are considered in-network for your insurance plan. Oftentimes, there's no way to guarantee that all the providers you see during an episode of care will be in-network; you could have a surgery with a surgeon who's in-network, and at a facility that's in-network, but get blindsided by a huge surprise bill from an out-of-network assisting surgeon or nurse or anesthesiologist, or by an out-of-network consult when you're in the ICU recovering after surgery. This is one example: https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...
There's been some progress in states (including CA) to cut down on these sorts of billing practices, thankfully, but it's still a major issue elsewhere, even if you have an ostensibly gold-plated health plan. Many plans are starting to remove caps on out-of-network bills, too: https://khn.org/news/2016-ppo-plans-remove-out-of-network-cost-limits-a-costly-trap-for-consumers/ https://khn.org/news/2016-ppo-plans-remove-out-of-network-co...
I assume something similar may have happened to OP, but there are a lot of other ways they can run up the bill. These kinds of billing practices are insane and need to stop.