How much clearer can maximum out of pocket be?
Edit: I do think in network and out of network should be easier/faster to figure out though.
I had an out patient surgery about a year ago and while my doctor and every admin I talked said that everything would be in network, I still had someone sneak in who was supposedly out of network.
Then came the bill of what should have been ~$300 was around $2500. I got that BS waived only by called my doctor's office and talking with them about it. Once we talked it all through, the nurses called the _head management of company that ran the out patient surgery clinic_ in order to get it removed. It feels like people have to do you favors in order to get your actual correct billing.
Our health care system is so royally f'ed in the U.S. It desperately needs fixing and I hope it does before something serious happens to myself or my wife because it's currently feels like gambling with ruination. No $2.5k isn't ruination but health care is the only thing in this country where I go in knowing NOTHING about what my final bill will actually be.
Or I wonder if a similar "HIPAA trap" could be constructed by categorically revoking consent to share your PMI with any out-of-network individuals and companies?
As for what's covered by my insurance, I strongly disagree that this is "clearly explained." It is not, some of it is outright "and other services," most of it is buried in pages of medical terms I don't understand.
My understanding is that past that point, you become mostly uninsurable, but maybe I'm wrong.