1. Doc recommends a long list of blood tests for reasons she can’t seem to articulate. She’ll also recommend a testing lab. Oh, and see this specialist!
2. Now I have to figure out:
a) which tests do I actually need and which ones are just being recommended out of abundance of caution or because the doc needs to protect herself legally?
b) will my insurance cover the tests I’m going to do? If not (or even if so) how much will they cost me?
c) will my insurance work at this particular lab? The lab often won’t know.
d) do I really need to see this specialist or is my doc just tossing some juicy business to her med school buddy?
e) is the specialist in my insurance’s network?
f) how much is the specialist’s bill likely to be?
g) how much will my insurance pay?
3. Do all the things (or not)
4. Random bills for random amounts start landing in my mailbox over the next few months. They could be anywhere between $100 and $10,000, totally impossible to know ahead of time. I now have to pick up the phone and start negotiating with the doctors and my own insurance company, figuring out what I can pay now, what will have to wait, etc. Usually the insurance company will say something about a deductible and “you have to pay LOL.”
The stress is enough to give me an ulcer (which I’d need to visit yet another specialist for, is this one in-network or out?)
There are still a occasional billing hiccups but the big tradeoff is that I can only visit the Kaiser hospitals except if I'm traveling and have an emergency.
Only if you have good insurance. Insurance companies have been cracking down on this behavior. For example, there are certain specialists which are straight-up not covered unless you have an explicit referral. Likewise, networks of providers will vary. For example, sometimes your area's top hospital won't be "in network", so you're now paying significantly more out-of-pocket for going out of network.
If you currently are enjoying this benefit, please anticipate that privilege to be gone within a decade, regardless of what direction the US healthcare market goes.