I'm an American, but live in the Netherlands. We have an annual €385 deductible, but the insurance providers basically exist only to process paperwork and transfer money as near as I can tell. I have never paid my doctor or the hospital for anything ... ever. The receptionists at both handle scheduling and chart entry and that is all. They don't and can't accept payment.

The insurance company receives my chart, determines what the mandated cost is for that service, and sends me updates throughout the year about my accrued total. At the end of the year, they debit my bank account for that amount.

My wife was diagnosed with type 2 diabetes this year after calling an ambulance for having what she thought was a stroke or seizure. After that, plus the subsequent doctor's appointments, lab work, a CT scan for something unrelated, all of her medication, followups with both a dietician and a few other things, her total bill was €93.