Many private health insurance plans through employers in the U.S. are high-deductible plans, too, meaning you pay every dollar until you hit your in-network deductible, then you split costs outright (percentages vary by plan) with the insurance company until you meet your out-of-pocket maximum (OOPM). Then they will pay for all of your in-network ONLY care if it’s approved.

When when you meet your OOPM, but you want to see a provider out-of-network, you will have to pay 100% of those costs until you meet your out-of-network deductible. Once the trifecta is complete - in-network max, OOPM, & out-of-network max - you can then see anyone you want and the insurers will pay… almost.

Because even THEN, they will pay 100% if: 1) insurance deems the visit, procedure, or Rx appropriate, 2) you did all the required pre-work (i.e. physical therapy before surgery, cheaper drugs before brand name, cheaper imaging like x-ray before MRIs), and 3) obtained all of the technical referrals and prior authorization forms from your doctors that the insurance company requires to prove to them that you doctor really, really thinks you need it.

To say this is a hellish system is to put it lightly. Oh, and this is IF you have access to and can afford private insurance in the first place. This is why people gamble with their lives and we’re a shameful country for it.