What treatments are you referring to when you mention paying out of pocket?
Imagine you are Tom Brady. After the first game of this upcoming NFL season, Tom Brady complains of a pulsatile ringing in one ear or both. Given his fame and value to his team, he will immediately be sent to the hospital for a thorough evaluation.
In a short time (days) Brady will be seen by multiple specialists - ENTs, neurologists, neurointerventional radiologists, cardiologists, and probably a host of others if necessary.
Doctors will give him extensive blood work and examine his external body thoroughly. They will examine his heart and vasculature comprehensively. They will exhaust every question possible regarding his pulsatile tinnitus to determine what makes it better or worse, if anything. Then they will give him comprehensive scans of his brain, neck, skull base, cervical spine, jaw, and temporal bone.
Some of the most educated and skilled professionals in the world will work together to analyze the scans and all the other data to try to find the problem. They will likely find the problem quickly because it is Tom Brady and his life matters. Your life - not so much, unless you have money or fame.
If you go to the doctor, the doctor might dismiss your concerns at first due to ignorance or apathy. Because the doctor is inundated with patients with crap insurance and has a tight schedule, you will get ten minutes at most to talk about your problem. The doctor will scribble some notes and likely forget about them forever as you are getting shooed out the door so they can profit from the next sheep walking through the door.
If you are lucky you will get an ENT appt. At the appt., the visit will be much the same. After a brief examination of your ears, you will be shooed away, maybe with an appt. for an MRI/MRA. Your scans will be analyzed by some unknown radiologist who doesn't know a vein from an artery ( hyperbolic, but representative of general ignorance). If the radiologist finds nothing, the ENT will say there is nothing I can do.
At that point, you are shuffled back to your primary care doctor who probably doesn't even have the scans. The doctor will be reluctant to give you any more referrals because the scans ruled out anything "dangerous." That is not true but who are you to question the almighty, right? At this point, you have probably been enduring PT for at least six months and still have no hope for a diagnosis or cure. Why?
BECAUSE YOU'RE NOT TOM BRADY.
Your insurance, like that of most Americans, entitles you to garbage treatment if their problem cannot be solved with an antibiotic, a shot or a pill. The only things you get that Tom Brady does not are:
1. A hard time.
2. A copay
Good luck. You'll need it.