Health Insurance Plans

Let me first say that I am not an advocate of universal health care. I understand the many benefits that it could have on our nation, but very little of that would be seen by me. When it comes to things like that, I choose to be selfish.
To me health care has always been something that my parents handled, not because I needed it, but because they are nurses and know the system. Both parents, at one time or another, have been able to recommend the best physician, get me a relatively quick appointment, or both. It wasn't until my shoulder surgery that I really learned about my own health insurance and how to deal with doctors, hospitals, and insurance. I know many people have probably done this already, but I wish i would have known how to deal with it at the time. It would have saved me a bunch of time on the back end.
Most PPOs (I refuse to use an HMO, because when I have an ailment I want to go straight to a specialist, not waste an appointment on a general practitioner) have three main parts: a deductible, a max out of pocket, and a percentage payment. the first and last I was quite aware of, but the second took me by surprise. Max out of pocket is the maximum amount you will have to pay in any given year. My insurance pays 80% with a $300 in network deductible and $1500 max out of pocket. First thing first, your deductible does not count towards your max out of pocket, which sucks.
Now when you go to a doctor (for the sake of brevity, doctor is meant to mean any charging health care facility), they are going to send you a bill straight away. DO NOT PAY THIS. The way this works is that the doctor gives a bill to you and your insurance for the percentage pay that each of you have agreed to pay by your plan. If your doctor charges $3,000 (once your deductible is paid), they will ask you to pay $600. Fair enough you think, but you would be wrong. Your doctor will send the remaining bill to your insurance ($2,400), and your insurance will tell the doctor that they will pay $1,000, and they will send their portion, $800, to the doctor. Your insurance will then credit your max out of pocket $200. If you paid the $600 bill you got from your doctor, you will have not only overpaid, but not gotten credit for that amount by your insurance company. This last part is especially bad when your insurance company is currently assessing a surgery billed to them at $38,000.
My advice is to wait until you get the magical statement in the mail from your insurance company or the doctor with the heading, "Your insurance company has already paid their portion of this bill". Then check your insurance statement to make sure their figures add up.
Now, the big hassle, of course, is why does your insurance not just pay the whole thing, and then send you a monthly bill like a credit card? If the max you can charge in one year is $1,800, would the insurance company not be better off to send you a monthly itemized bill, then charge a reasonable APR on and charges that are not closed by the end of the year? My intuition is that many people default on high medical bills, so your insurance company would rather have you default with the hospital than pay out money on your behalf and have you default with them.
In closing, I will let you know how easy it is to try and get a $400 refund from an orthopaedic surgeon.