The Achy Elation of Hitting The “Annual Max Out-Of-Pocket”

Today, I encountered a mythical unicorn wearing a sombrero and singing karaoke! I’m just kidding, but I did experience something completely unheard of: I reached the annual maximum out-of-pocket for my health insurance, meaning that my provider pays 100% for the the rest of the year. Score!

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This means that:

  • My upcoming echocardiogram is free!
  • The spinal tap next week is free!
  • My expensive-as-hell anti-fungal prescription is now free!
  • My ongoing monthly checkups, lab work, and imagining will be free!

I feel like I hit the jackpot, though I know how contradictory this sounds, seeing as that I’ve spent over $10,000 between in-network and out-of-network treatment in the last seven months, and will continue to pay my $550 monthly premiums.

It’s like going to the store for one item and then impulsively picking up five more to qualify for the shitty free gift you don’t even want. How can you pass on this sample-sized foundation in the wrong skin tone? You absolutely need this cheap tote with our brand logo on it!

In medicine, the contradiction is not based solely on poor judgement, but on concerned doctors mitigating their liability after failing to recognize a potentially fatal disease at onset. You have good health insurance, right? Let’s run all the tests!

So, over the last 212 days, we have run all the tests to trace where in my body the disease has taken up residency, and what effect the infection it is having on my organ function.

I’ve never been in this situation before. Do I get a refund for the overage amount, like with income taxes? Or will the medical assistants wave their lovely arm and say that I’m good to go?

Is this real life? Do I really get to start replenishing my ever-shrinking emergency savings account? The bills have been so overwhelming that it’s almost hard-to-believe, and I’m so thankful that I’ve always had a “hope for the best, but prepare for the worst” mindset.

I have spent a significant amount of money on health costs this year, with over $6,000 at my in-network discounted rate. Ouch!

Here are something I could have spent that money on instead:

  • 75″ QLED Smart 4K TV with HDR
  • Copenhagen full bedroom set
  • 6 iPhone X phones
  • 18.5% of an average new car
  • 124 sessions with my personal trainer
  • 1,240 fast food meals

So, maybe I didn’t win the lottery after all.

However, I am still alive, possibly thanks to all the wallet-sucking interventional treatment I’ve received over the last several months. I’m realizing that in itself is reason to feel grateful, even if all I get in return is a slew of needle bruises, rash scarring, or a paper-thin tote bag with my doctor’s name on it.

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