In the US, how do people go bankrupt from medical bills when most insurance have a max out of pocket?

Question

Just was thinking about this the other day while looking at my insurance. How do people in the U.S. accumulate huge bills without hitting their max out of pockets? Are cancer treatments not usually covered by insurance? Are the doctors that provide the treatment just happening to be out of network?

I guess I’m wondering if there is anyway I can plan to not be in a situation of me or my husband rejecting treatment and dying or having huge medical bills cripple us. We’re relatively healthy now, but the future is near.

I’d like to understand better how it seems to be so *common* for people to not be covered by their out of pocket max.

Thanks.

In: 4623

Answer 1

We had “good” insurance when my wife became seriously ill.

When you are hospitalized in the US you don’t get one medical bill. You get a bill from the hospital, a bill from the internal medicine physician, a bill from the obgyn physician, a bill from the critical care physician, a bill from the lab, a bill from the radiologist private practice, etc.

The insurance company can and will say that some or all of those bills are not covered for a ton of different reasons that you agreed to when you signed up for the coverage. Those reasons for lack of coverage will change and overlap as you try and fight for them to be covered. The amounts will also change over time as the insurance fights with you and the hospital to pay as little as possible. Some of those bills won’t show up for months. Just trying to keep track of everything to be able to properly fight with the insurance is a nightmare.

And if you can’t convince the insurance that the costs should be covered then they aren’t included out of pocket maximums. Which means you are on the hook for all those dollars.

In the case of serious illness, like my wife’s, that can be hundreds of thousands of dollars. Even when you have “good” insurance.

We managed to get the largest things covered so we didn’t go bankrupt, but it took almost two years, hours of times, oodles of stress and frustration.

After living in the US, the UK, and Canada, I can confidently tell you the US system is terrible. The UK and Canada aren’t perfect – but the US system is terrible.