Insurance in general typically has deductibles (auto, home, renters, etc). for which you are responsible for first before the insurance kicks in. This is beneficial since it allows for lower premiums and lets customers pay out of pocket for expenses that they can afford. As a concept, it only makes sense to purchase insurance for expenses that you cannot afford.
>So when you hear about those people who get lumped with $100k medical bills they still have to pay like $20k of that on top of your insurance?
It depends if the person was insured or not, and if the care was provided by healthcare providers who have contracts with the insurance company or not (referred to as being in network).
In the US, when you go to a healthcare provider, the first thing they will ask you to sign is a form acknowledging you know you are responsible for anything your insurance company does not pay for (unless you go to a vertically integrated healthcare / health insurance company like Kaiser Permanente). In fact, health insurance companies are better referred to as managed care organizations (MCOs) in the US.
What happens is people are not capable of knowing what healthcare services they need or do not need. They have no way to determine if they are being ripped of or not. So the MCOs employ legions of doctors and pharmacists and whatnot to double check the doctors performing the services. They also have enough knowledge about pricing healthcare procedures that they are more able to determine a "good" price to pay.
Anyway, after the ACA law, there is an out of pocket maximum for in network providers, so you would not get a $100k bill. the out of pocket maximum for individual / family is $8,550 / $17.1k in 2021:
So you would only be liable up to that amount at most in a calendar year for all healthcare you receive from an in network provider. Everything else is paid for by insurance.
>What happens if you can't afford the remaining percentage?
The healthcare provider can choose to go after you for it, since you signed the form that says you will pay them if insurance does not. If you feel your insurance denied the doctor inappropriately, you can appeal to a third party to determine if insurance is obliged to pay it (if it is evidence based medicine, then they most likely have to pay it).
>So when you hear about those people who get lumped with $100k medical bills they still have to pay like $20k of that on top of your insurance?
It depends if the person was insured or not, and if the care was provided by healthcare providers who have contracts with the insurance company or not (referred to as being in network).
In the US, when you go to a healthcare provider, the first thing they will ask you to sign is a form acknowledging you know you are responsible for anything your insurance company does not pay for (unless you go to a vertically integrated healthcare / health insurance company like Kaiser Permanente). In fact, health insurance companies are better referred to as managed care organizations (MCOs) in the US.
What happens is people are not capable of knowing what healthcare services they need or do not need. They have no way to determine if they are being ripped of or not. So the MCOs employ legions of doctors and pharmacists and whatnot to double check the doctors performing the services. They also have enough knowledge about pricing healthcare procedures that they are more able to determine a "good" price to pay.
Anyway, after the ACA law, there is an out of pocket maximum for in network providers, so you would not get a $100k bill. the out of pocket maximum for individual / family is $8,550 / $17.1k in 2021:
https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
So you would only be liable up to that amount at most in a calendar year for all healthcare you receive from an in network provider. Everything else is paid for by insurance.
>What happens if you can't afford the remaining percentage?
The healthcare provider can choose to go after you for it, since you signed the form that says you will pay them if insurance does not. If you feel your insurance denied the doctor inappropriately, you can appeal to a third party to determine if insurance is obliged to pay it (if it is evidence based medicine, then they most likely have to pay it).