The action you can take if you disagree with a decision your insurance company has made about your coverage or payment. You can

A healthcare organization, often made up of providers, that agrees to be accountable for the quality, cost, and overall care of a group of people, typically with its revenue tied to quality metrics and cost of care.  The organization typically contracts with a combination of hospitals, primary care physicians, and specialists to provide care to the specified population. 

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The out-of-pocket maximum is a limit on what you pay out on top of your premiums during a policy period for deductibles, coinsurance and copays. Once you reach your out-of-pocket maximum, your health insurance will pay for 100% of most covered health benefits for the rest of that policy period. The next policy period (plan year), it starts all over again - note: the policy year may not coincide with the calendar year.

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