Almost everyone with insurance has a maximum out of pocket limit now. It's possible to have a grandfathered employer health plan, but they'd have to have been running it since 2010 without substantial changes since then, including in benefits or cost increases. There are very few employer health insurance plans that would have met that criteria, and even fewer who tried to.
They also have to directly inform you that you're on a grandfathered plan, so it should not be a mystery to those who somehow are.
"maximum out of pocket" does not mean what any normal person would interpret it to mean. More than one year I have had to pay way more than the "maximum out of pocket".
The insurance company gets to decide unilaterally how much of what you pay out of pocket is credited toward their tally of what you supposedly paid out of pocket. In several years I've paid a lot more out of pocket than what the insurance statement credits me for having paid.
How it works is that blue shield (with employers I've typically always had blue shield in California) sends a statement saying your doctor visit cost $XXXX, blue shield will pay $YYY and this will credit $ZZZ towards your annual out of pocket total.
But $XXXX - $YYY > $ZZZ, so what I actually had to pay to the doctor was more than blue shield credits me for having paid. So at the end of the year what I've actually had to pay has been well above the so-called "out of pocket maximum".
It doesn't happen most years (to me), but has happened on multiple years.
Labs that don't have a clear medical justification are probably easy to end up paying for out of pocket without getting the amount counted against the out of pocket insurance limit.
Would expect that to be clearly delineated on the bills though.
I hear you about the health care situation though. Health insurance is definitely not the same thing as health care.
https://aspe.hhs.gov/sites/default/files/migrated_legacy_fil...
My buddy separated his shoulder snowboarding when he was 22, but had no health insurance because he was working at the ski resort for something like $6/hr (US Ski Resorts are legally allowed to pay below minimum wage... go figure).
So he never went to the Doctor, because he couldn't afford it. He's 41 now, and that shoulder impacts almost every day of his life.
Oh, I'm not American, and actually I was there as a 22 year old Australian and was horrified. The idea that people in a Developed country didn't have access to a doctor was shocking - I'd never seen that before, and simply didn't understand. I thought everyone could just go to the doctor when they needed to.
Here's a bit of an anecdote, but I bet my family isn't alone in this type of story... my cousin died from cardiac arrest at age 45. Keeping the story here brief - he was a high-income business owner who got into a tough spot in his marriage and business, found himself without health insurance when he had a medical episode. Knew something was wrong and would likely bankrupt him - and we think that's why he didn't follow up with his doctor and was dead two weeks later. Congenital issue, could have been easily resolved - but without health insurance it was probably a death sentence either physically or financially.
Now, this was just as the ACA was coming into play - but I'd argue it's moot. The ACA was well-intentioned, but has not actually improved the insurance or care situation for the majority of Americans. I need a surgery at present that won't be covered by my insurance to any meaningful degree, and being in rural America my care options are limited. So I'll live with regular pain because the system doesn't work. And I hear stories like this in my social circles weekly.