Prolonged inpatient hospital stays as a cause of bankruptcy

I've heard of inpatient hospital stays that ranged in the low 7 figures, and I remember when I worked as an internist realizing that an underinsured patient of mine was basically being forced by the hospital to choose between bankruptcy/staying alive or financial solvency/death. The hospital didn't deny her care based on finances, but it was still striking to realize that this was essentially the choice she was facing.

I think chronic end of life care may be a more common cause of bankruptcy, but based on my current demographics an unexpected inpatient stay is the bigger risk for me.

And despite working in medicine, insurance has always been confusing to me — I don't fully understand how inpatient hospital stays are covered under different plans.

So on that note, I'd appreciate any educational insight you insurance gurus could provide on this point.

To illustrate my question, this is a sample quote from Blue Shield for a single 30 year old male that I got from their website. I wanted to highlight a few lines in its description that I didn't quite understand:

Silver 70 Off Exchange Trio HMO – $498/month

$5,400 – Individual Deductible

$8,700 – Individual Out of Pocket Max

Hospital Stays -Before deductible: Full cost After deductible: 30%

So, say you're bit by a snake while hiking or have trouble with childbirth and end up with a 7 figure hospital bill.

Under this plan, I understand that you would you be responsible for the first $5,400 until your deductible was met.

After the deductible, would you then be responsible for 30% (ie. $300,000) or would your bill cap at your out-of-pocket max at $8,700?

That is to say, does the individual out of pocket max serve as an upper limit for the hospital stay?

I asked two different Blue Shield reps this same question, and got two different answers. But thinking back to patients with exorbitant medical bills, how would the numbers get so high if their insurance had an out of pocket cap?

Someone is probably going to say I can't believe you're a doctor and don't understand how insurance works, but yes to some degree that's unfortunately the case. We didn't get any education about this in medical school, and I've never really had a head for numbers/contracts. Any help filling this gap in my education would be sincerely appreciated.

submitted by /u/Theartofdumbingdown
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