I don’t know about you, but it seems health insurance companies don’t have our best interests at heart

20 Replies to “How US Health Insurance Works”

  1. Thank you for watching this summary of US health insurance. For $300 per month you can subscribe to my channel.

    1. This was strangely appropriate for me today. Was Google listening to my conversation with BC/BS yesterday?! I’ll sum it up for you: “So I pay $1600 per month in premiums for 2 people and have a $7000 deductible per person, so that means I just have insurance in case I need something big like surgery, and now you say you will not cover the much-needed surgery I have scheduled?

      “Yes, maam”.

      I would like you to send me in writing why you are denying covering my surgery and the steps for appealing it.

      “Maam, I am telling you right now why we aren’t covering it and you cannot appeal the decision. However if your doctor were to somehow find that you have 4 ribs dislocated and broken away from the costal arch, it will be covered. But 3 dislocated ribs is not covered.”

      You realize I’m in serious pain and have had to quit my job and can’t reach over my head, right?

      “I’m sorry ma’am but we don’t cover 3 dislocated ribs.”

      This surgeon has done over 300 of these surgeries with excellent success and has published the results in Annals of Thoracic Surgery, right?

      “Is there anything ELSE I can help you with?”

    2. Oh I know! Make one how the fda approves drugs and new vaccines!!!!

      Oh wait, you already mocked and belittled all the healthcare workers who were fired for not getting vaccinated. Never mind. Despite calling out healthcare abuses throughout, you’ll avoid the travesty of a process that got big pharma billions of dollars, 75 years to release data (that the fda requires much smaller biopharms) to produce ad nauseam BEFORE approval), and laws/stipulations that strip any responsibility or liability from those same fast tracked approved big pharma companies for the vaccine…which now no longer even prevents the disease, if it ever did to begin with.

      You’re a coward.

  2. Monthly premiums 300-500$
    Out of network, you pay it all upfront to the doctor… and maybe get 5 or 10$ for it if you file your own claim.

    In network…

    PPO – chose your doc
    HMO – must see one doc called a PCP for all things, no choice, referrals are a b!+ch

    Deductible
    Yes, like what you have to pay on a car if you have an accident but this is on your Healthcare yearly, each year this renews back to zero and you go back to paying on the deductible first.
    PPO 2.5K to 1k
    HMO 1K to 500$
    *Rare [hmo] cases no deductible, or only inpatient stays will have a deductible, but the catch is a higher coinsurance and higher co-pays paid, like ppo level coinsurance!

    Coinsurance
    PPO 20% up to 2.5k max
    Or Sometimes a flat fee of 50 to 100$ depending on the kind of care/visit.
    HMO 10% up to 1k
    Or sometimes a flat fee of 10 to 100$ depending on the kind of care/visit, sometimes this is limited to a higher type of care like hospital visits not normal pcp visits.

    Copay
    PPO 25$ each visit any doc
    HMO 10$ to 20$ each visit, depending and that’s for only your pcp or to the referred doc. These amounts do not (generally) apply to MOOP.

    Max out of pocket (MOOP)
    3k to 1.5 depending on PPO/HMO this varies. Good luck finding out what it is, if it’s over 2k they don’t like to advertise this, and it’s most likely NOT in any of the pamphlet paperwork but must be on the contract [somewhere].

    Surprise billing (where you see an out of network doc but didn’t have a chance to choose an innetwork doc, like because you were unconscious) this is becoming a thing… where there’s been new laws about regulating how these can be billed or how the patients are notified of them and eventually if they qualify as a surprise bill it’s paid at a rate closer to in network but this is still very very messy… and many don’t qualify, because it has to be things like you were literally unconscious and they didn’t know if you had insurance let alone what brand or plan type.

    Edit: spelling

    Edit 2: ambulances are nearly ALWAYS out of network
    (enought so I should just say always and leave out the nearly but some rural “towns” has it *_subsidized_* so it’s paid by the city and county but this is so rare that it’s a unicorn or else it’s locally disaster related and so the state does pay for it but only if you file a claim to the state to recoup based on disaster claims…)

  3. I don’t think what you said about finding in-network doctors is true. Health plans have a list of in-network doctors you can use to search for doctors you need. Not that the list is always accurate and up-to-date, but they do try to make it right.

  4. The only thing inaccurate about this video is that the customer service actually answers your questions efficiently instead of transferring you to another operator where you wait 10min on hold and provide them with your personal information all over again just to receive no useful information after 2 hours on phone.

  5. I work with insurance and patients on the regular. The insurance company denied paying for a patients ultrasound……..cause they didnt have an ultrasound

  6. I’m 24 and recently had a wisdom tooth removed. The surgery costed $1500+, but with my mother’s MediSave (It’s a medical scheme here in Singapore. It deducts a percentage of your pay and saves it for when you need medical help), we only had to pay about $350. Still quite a large sum, but def beats paying almost $2k for a single tooth removal.

  7. Want a low deductible? Want low Maximum out of pocket? Then pay a higher premium. As for looking if your doctor is in network. Look it up on the website, call your insurance agent have them look it up, or call member services. if you want to not have to worry about out of network. Get a PPO not an HMO. Never get an EPO. Unless that is the only one your doctor will take. Guys it is not just the Insurance company’s fault, there are three groups to blame here. 1. Insurance Company’s 2. Doctor’s 3. Government.

  8. People can say whatever they want about Brazil, but I have never ever worried about any single medical bill when I got my insurance. Also, my grandmother, after her first heart attack, lived + 15 years thankfully to free healthcare doing surgeries and receiving medicine 🙂

  9. Paying middleman to pay your bills isn’t a business model it’s either charity or a scam, it started off as one then transitioned to the other

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