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Commercial insurance also called Major medical insurance is not as available as it once was to employers or individuals.  They are sometimes offered now to foreign travelers to cover any medical expenses in the U.S.  The insurance covered 80%, 90% and rarely 100% of almost all charges to any medical facility or physician that the patient goes to with the patient responsible for whatever balance the insurance did not pay for.  They did not require any referrals or pre-certifications for services but would often require a claim form to be filled out by the client.  They often have a yearly and a lifetime maximum of payments.  

Indemnity plans do not have to pay the hospital or doctor.   The  plans are designed to indemnify either the insured or the provider. That means if you have services that cost 20,000.00 dollars and you opt for the insurance company to pay you they will make the check payable to you. You can then negotiate with the provider for a better deal and keep the difference in cash.