Ask Lemmy

For people with insurance, there’s pretty much always a maximum yearly out of pocket amount, after which things are basically all paid for by insurance.

With a few caveats, yes. At least with the insurance I had last year when I hit the max for the first time, it has to be both deemed medically necessary to do, and be in network. Just because you hit your annual out-of-pocket max doesn't mean you can get free cosmetic surgery, for example. Out of network treatment also had a separate annual max, so if I saw the wrong specialist or went to the wrong hospital during an emergency, I could still have gotten hit with another $10,000 in bills before that kicked in. And finally, I learned that there are actually annual maximums for certain types of treatment. In my case, I have an autoimmune condition and my doctor wanted me to get blood work done for it every 3 months. In their boundless wisdom, my insurance decided I shouldn't need blood work more than three times a year, and I got a $1,700 bill for going over the annual limit for such care.

The limitlessness of their wisdom and beneficence is matched only by my pettiness, so I had the pleasure of having my first colonoscopy and an endoscopy the day after Christmas because my gastro said there was a tiny possibility of me having a problem more serious than hemorrhoids and I knew those assholes would have to pay for it, since they pre-authorized it, which added a few grand to what they had to pay for the year.