> after the $6,500 max, all expenses are paid
In practice, the insurance companies find ways to increase your out of pocket, or just outright not pay. Let me give my personal example.
I have a medical issue where I will be on a certain drug for the rest of my life. The issue is completely taken care of by this drug, and all medical literature that I can find (and my doctor) says this is the correct treatment. After a year of insurance paying for the drug smoothly, I arrive at the pharmacy and insurance is no longer paying. The insurance company says my "pre approval" has expired and that process takes a week Ok, since I could die without my medication, I pay cash out of pocket. Meanwhile, my doctor calls them for "pre approval", and supposedly it is cleared up. A month goes by, I show up in the pharmacy, the insurance company will only pay for half the dosage. So I pay cash for half, and call my doctor, who says they applied correctly, the insurance company made a mistake, and they will reapply for "pre approval". Boom, I've exceeded my "supposedly" out of pocket max. Welcome to my world of the insurance company refuses to pay by being difficult and sleazy and slow.
So in practice, there is this new part of the system nobody is warning us about. Everybody thinks if the treatment is well understood and your doctor prescribes the treatment then the insurance company MUST PAY, but this is not true. The insurance company can (and regularly does) simply refuse to pay AT THE LAST MINUTE WITH NO WARNING because . Side note: sometimes the reason is there is a cheaper, yet less effective treatment, I ran into that for a DIFFERENT medication once. But my doctor cannot possibly seem to check this in advance? I always find out at the pharmacy at the final moment as I attempt to leave with the drug?
Don't misunderstand me, I do not have a solution for health care, I don't know if single payer would be better or worse, I don't know how to lower costs, and there may not exist a better system than what we have now. But I do know I dislike the current system, it feels antiquated and inefficient. My pharmacy, doctor, and insurance company use FAX to communicate. FAX?! There is no ticketing system where I can keep the pre approval moving along, or where I can double check the final outcome. And it seems clear to me the insurance company is overstepping their bounds. When you get a correct, legitimate prescription, they should pay, but that is not the current system.