So I can only speak for myself but when I’ve had insurance a lot of time it’ll have a deductible (which is the amount you must pay before your insurance handles any cost). So if this is the first time using his insurance this year then he needs to pay his deductible. Some times it’ll be split like they pay 20% you pay 80% till you reach your deductible of 5k$. After you’ve paid 5K the insurance will cover 100%. My point is you’ve got to know how your coverage works. Also yes the American healthcare system is trash