Talk to somebody who has a chronic illness or multi year cancer. There are plenty ways to charge people way more than their out of pocket maximums. People also get worn down by constant mistakes and weird bureaucratic hurdles by hospitals and insurance.

I always wonder about those. Are they real? Or will insurance companies find exclusions or ways to mark things as out of network and the maximums don't apply?

Right, my insurance company tries to weasel out of paying for things all the time. I have zero confidence in the maximums.