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

Keep in mind that insurance companies are in it for profit, not to help people. [Health insurance providers are reaping simply *massive* profits](https://www.beckerspayer.com/payer/the-house-always-wins-health-systems-face-worst-finances-in-decades-as-payers-rake-in-record-profits.html), and all that profitability comes from maximizing income and minimizing spending. Which means they’re trying to pay as little in benefits as humanly possible.

So if you work for a big company, you might have a decent plan, but you’ll often have to fight your insurer for all sorts of things your providers say is necessary care. If you don’t have insurance from a group plan, you may pay astronomically for shit insurance.

My wife and I (both self employed) dropped from the insurance pool when out premiums (for shit coverage) hit a grand a month. I looked into insurance last year and it would be $1400/month for us (52 & 60, perfect health, non-smokers and no pre-existing conditions) for a pretty crappy plan. My wife injured her hand a while back, severed a nerve and tendons and required an ER visit, micro-surgery and PT, total over a year was about $18K. But we’ve avoided paying something like $40K for premiums, so this time – we’re ahead. next time, who knows.

“For-profit health insurance” is one of the most abysmal phrases in the English language. It’s just another absolutely, blatantly stupid thing we just seem to accept in the US.