ACA insurance. what you need to know about forced shit insurance

[uppityperson]

83. Not right. Insurance can be difficult to understand. Let me try.

Let's say you go to the hospital, they say you have a bill of $500,000. They send it to the insurance company.

If the insurance company says "usual and customary bill is $100,000 not $500,000", the hospital will have to write off $400,000. This is typical.

The insurance company will pay their part, $60,000 leaving you $40,000. However, that is more than your max out of pocket a year, so you are liable for only $6500. That is what you can be billed for. Period.

The question here seems to be what happens to the other rest of the $40,000. The facility must write it off. They can not bill you next year for more on that bill beyond that initial $6500.

You ARE liable for the max out of pocket, including interest, until it is paid in full. And they can continue to fill you every year for that original $6500 until you have given them the amount of your annual max out of pocket for the year and ONLY for the year you got the bill initially.

This is why people get more things done later in the year than in the beginning because they are more likely to have met their annual deductible and max out of pocket expenses.

But yes. The extra amount beyond the deductible/max out of pocket (you say legally mandated $6350/yr) IS written off. They can ONLY bill you for the original amount to meet your ded/max out of pocket. And they will continue to bill you until that bill and only that bill is paid off.