I'm not sure what to make of your insurance question here so bare with me. I'm not an insurance expert and I know there are a variety of different policies throughout the US. Some of these policies are private some employer-based and others are from the Exchange or an expansion of Medicaid. Your location and employment will determine which policies are available to you for the most part even using the Exchanges.
As for not paying out of pocket...I'm not sure how that would work. Most private/employer insurance works on the deductible/co-insurance/coverage and is dependent on your local health network as to the contribution you are required to pay. Getting GCS with insurance isn't billed the same as it would be if you were paying a cash price and those inflated charges add up to more out-of-pocket for the patient. If I had to guess, I would say that most people using their insurance are paying the annual maximum, out-of-pocket expenses. This will amount to several thousand even with the best insurance.
I don't know if this helps or not. Maybe someone else can confirm whether this was the same for them.