4 ms·

I used to be me worried until I realized about the out of pocket maximum. But I'm still not sure how it works in practice. Are there ways that hospitals could c

I used to be me worried until I realized about the out of pocket maximum. But I'm still not sure how it works in practice. Are there ways that hospitals could charge for things that are considered separate from that number, like out of network or not covered things in the insurance plan? There always seem to be extra charges from what the health plans advertise, so I hesitate to trust their out of pocket maximum too.

lotsofpulp 4y ago
The big risk used to be getting billed by an out of network provider while you are at an in network facility. Such as getting a surprise bill for $10k from an anesthesiologist that you had no idea was out of network since you thought your hospital was in network and there was no need or ability to check. But as of Jan 1, 2022 that is no longer a concern: https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill... The other concern was getting out of network care due to an emergency where you cannot choose in network care, but that is also no longer a concern per above link. I have had two child births in the past 6 years, and both years we hit our family oop max (~$5k), and after that, we did not have to pay a cent. We took the opportunity to get a whole bunch of healthcare like seeing an ENT, dermatologist, vasectomy, physical therapy to recover from childbirth, etc and all were fully paid for. I always use the insurer’s website to find in network providers, and I can even get a procedure/diagnosis code and get estimated costs before a visit.
- mariojv 4y ago
  Thank you for posting this! I had no idea that surprise out of network billing and surprise emergency billing were no longer allowed. Among many, many other things, that was one of my biggest gripes with the US healthcare system. Walking down the street you run the risk of bankruptcy from simply existing, if you have to get emergency care while unconscious.

lotsofpulp 4y ago

The big risk used to be getting billed by an out of network provider while you are at an in network facility. Such as getting a surprise bill for $10k from an anesthesiologist that you had no idea was out of network since you thought your hospital was in network and there was no need or ability to check. But as of Jan 1, 2022 that is no longer a concern: https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill... The other concern was getting out of network care due to an emergency where you cannot choose in network care, but that is also no longer a concern per above link. I have had two child births in the past 6 years, and both years we hit our family oop max (~$5k), and after that, we did not have to pay a cent. We took the opportunity to get a whole bunch of healthcare like seeing an ENT, dermatologist, vasectomy, physical therapy to recover from childbirth, etc and all were fully paid for. I always use the insurer’s website to find in network providers, and I can even get a procedure/diagnosis code and get estimated costs before a visit.

mariojv 4y ago
Thank you for posting this! I had no idea that surprise out of network billing and surprise emergency billing were no longer allowed. Among many, many other things, that was one of my biggest gripes with the US healthcare system. Walking down the street you run the risk of bankruptcy from simply existing, if you have to get emergency care while unconscious.