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Time Magazine has a good story on so called "surprise bills" that could total tens of thousands of dollars over and above your Obamacare maximum out-of-pocket limit. Even if you choose an in-network hospital and in-network doctor, you could still be left with a big stick up your behind. Consumer Reports estimates that 1 out of 3 Americans with private health plans have suffered financial rape during the past two years. [Note: If you have fee-for-service Medicare, this doesn't appear to be a problem.] There is no limit to what an ethically-challenged doctor or hospital administrator can charge you for an out-of-network medical procedure - five times the in-network charge is common, 20 or 100 times not unheard of.

At one point in that nightmare, the medical bills started rolling in. A few thousand here. Ten thousand there. Twenty-two thousand more. By end of the year, Elfrank-Dana was staring down roughly $106,000 in medical bills. And none of it was covered by his insurance.

“My insurance had made payments to the hospital and anesthesiologist but it was a fraction of what they were asking,” Elfrank-Dana told TIME recently. “So they started going after me for the balance.”

The second issue has to do with the total amount that patients can be charged out-of-pocket. Under Obamacare, insurers are required to cap out-of-pocket payments at $6,850 (and $13,700 for families). Again, that’s progress. But those caps only include in-network care. If a patient like Elfrank-Dana reaches the $6,850 cap, but then receives $80,000 in surprise, out-of-network bills, after leaving the hospital, then, well, he’s out of luck.

The big question on most people’s mind is who’s to blame. And the answer is a political hot potato: if you pass a law that prohibits saddling patients with “surprise bills,” then someone else is going to be on the hook. And that someone else will be one of the three most powerful players in the American medical industry: insurance companies, hospitals and the physicians lobby. None of them want to be left holding the bag.


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