I can't see how you could unknowingly rack up $500,000 in out of network charges in an hour. I know doctors are paid a lot, but not that much! I can see them sneaking in a specialist during your in network surgery which might end up costing you $30k or so, but I would fight the charges personally if I had done my due diligence for the previously planned operation (emergency operations would be covered by almost all ACA insurance, in network or out of network). So I am ready to hear about out of network $500,000 charges if anyone on here has experienced that.
Perhaps it's not the 25%-50% hit to Net worth that people are afraid of, but rather the 50%+ of an entire year's living expenses that could 'easily' pop up in some scenarios.
You or a loved one breaks a bone. It is not life threatening..but you are probably in pain and need to get help fast. You go to the ER, they fix you up and send you out. There could be 4 different doctors that touch your file and put their names on the billing invoices, 2 or 3 different rooms they put you in for the various tests/services.
By the end of it all, your 'out of network' experience for a broken something could very well total $20k-$30k if it's not in-network, using various rack-rates for healthcare services. Perhaps even more. Imagine if your homeowner's coverage only covered certain fires, and you don't know until after the fire if the incident is covered or not. Wouldn't you be a little more nervous about shopping around for homeowner's coverage?
Was it a life-threatening experience that required you to go to the nearest ER whether in network or not? I would assume that it is NOT covered...since even if you have a heart attack and go to the nearest ER, all they cover is to "stabilize" you.
And consider the heart attack - if you go to the nearest ER in a life-threatening emergency and they stabilize you, are you really going to get transferred to the nearest in-network hospital as soon as you are considered "stabilized", or are you going to wait a day or two at the out-of-network hospital to get just a little more stable?
I don't know if there even is a definite point where you say "ok, now this patient is "stabilized" for health insurance purposes, they can be moved to a network hospital now - in a life threatening situation, there will likely be various tests and procedures they do on you over the course of several days. If you go to the ER on day 1, they could do a procedure on day 1 or day 2 that they need to wait 24-48 hours to review your progress on. On day 3, you are "stabilized", and ask to be transferred to a network facility, but they don't recommend discharging or transferring you until day 4 when the day 2 procedure results are known. In the meantime, they put you in an ICU room.
And while you're at the out-of-network hospital, they do a myriad of follow-up tests once you are somewhat stabilized, give you various drugs, and a staff of various people come by your room to examine you.
All of this while you are half-drugged and perhaps not in a sound, clear mind.
And even if you are moved to an in-network hospital for a major incident after your are "stabilized", there could still be a variety of people that are billed to your account that may not be covered. Or a variety of drugs that aren't in your network formulary that the house doctor decided to proscribe, without checking first to see if they are in your drug formulary plan.
I haven't personally encountered this level, but have seen various stories of people encountering this on a lesser degree for relatively more minor incidents (example: appendix removal), where just 1 or 2 bills were "out of network" and suddenly skyrocket in cost. Extrapolate it out for a more serious incident involving 2x-4x as many specialists and doctors and procedures, and your 'out of network' costs grow exponentially.
