Good morning. Welcome to Actios today. It's Tuesday, November 16th. I'm Nile Boudou. Here's what we're watching today.

The future of At Home COVID testing. Plus Florida's special legislative session against mass and vaccine mandates.

But first, today's one big thing. Out-of-network healthcare costs been out of control.

People who have health insurance, but get sick with diseases that require out-of-network care, can face staggering costs in this country.

My name is Cindy Beckwith. I live in Bolton, Connecticut. I was diagnosed in 2017, incidentally with a rare disease, caused by the muscular dysplasia.

My doctor at the time wanted me to see a doctor at the University of Pennsylvania in Philadelphia. My total out-of-pocket for the two surgeries was close to in around $20,000.

I just have gotten the feeling that it has become more about the money than a patient care.

Cindy isn't alone. We found her because of Bob Herman, a health care business reporter at Axios who's been investigating why the system works this way and what can be done about it. Hi, Bob.

Hey, Nile.

So federal regulations cap how much people pay out-of-pocket for in-network care, but there isn't a limit for out-of-network care?

That's right. For any type of in-network care if you go to an in-network doctor and in-network hospital, there is a maximum that people would have to pay out-of-pocket for that care.

However, let's say you get a rare disease or a cancer and you have to go somewhere far out of state and that hospital and doctor is not in your insurance plan's network, there might not be a cap on that care.

So that means if you need to go far out of state for really specific types of care, you could be on the hook for potentially all the costs and that could be tens of thousands of dollars, it could be hundreds of thousands of dollars, it could be more.

Obviously, these are rare instances, but it could affect literally any one of us.

What would need to happen in terms of the system changing to avoid people being in the situation that Cindy is in?

So Cindy's situation, I don't know that there is an easy fix.

Out-of-network care exists as a means to make sure that people go to doctors and hospitals that have agreed to see those patients.

The idea is if you stay within the network, we can control costs and you can still good care within the network.

There's really nothing out there right now to suggest that there will be a national network anytime soon and that obviously gets into calls for Medicare for All, but obviously that is quite politicized.

What does that say about our healthcare system in this country right now?

People in general, whether it's in-network care or out-of-network care, get bombarded with medical bills.

They get something in the mail and it says they owe tens of thousands of dollars for care that obviously they're grateful for,

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