[smileysteve]

You're conflating in-network, out of network with HSA -- as these also apply for POS and HMO plans - only traditional plans don't get the plan cost savings, tax deduction, (or if they're lucky the employers savings into an HSA account)

Your bicycling example isn't far off though (as someone who had an HSA and was in a bicycling accident). I had a ~$3600 deductible, and that was spent between an ambulance ride, ER visit, blood test, and MRI.

So, at that point, all costs would be on my insurer and I would theoretically no longer care to price discriminate for follow up visits (to get stitches removed)

I still have an HSA, though I make sure I get the lower deductible now.