I have never seen a health-care plan in the US with real out-of-pocket maxes. The fine-print is crazy on those clauses. We got burned by going to an ER while traveling, and while the ER bill was covered under out-of-pocket maxes, both doctors who saw our son in the ER were not employees of the ER, and so counted as neither in-network nor emergency room care. Basically 90% of the bill was not subject to the out-of-pocket maximum on our plan.

Washington state passed a law making this sort of balance billing illegal, effective Jan 1 2020.

It's a huge problem nationwide, though, and ultimately needs to get addressed at the federal level. It's absolutely insane and fraudulent that an in-network hospital has out-of-network providers within it.

I have always had an option for a plan that has an explicit out of pocket max for out of network costs. Maybe that's not very common.

We have that option to, and I looked at switching to it, but the list of exceptions to the out-of-network costs was still fairly long and contained words that I wasn't sure what they meant in the context of a legal document. Considering we'd be paying about $20k more out-of-pocket with that plan in a typical year, I wasn't sure if "getting a smaller list of exceptions" was worth it.

One chilling exception I found with a previous employer was in the small print with "premium" cancer treatment medications. I kept thinking cancer is a primary case where I really do not want to worry about if my chemo drugs are on the premium list or not to avoid out of pocket costs.