A terrible guide to the terrible terminology of U.S. Health Insurance
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- Опубликовано: 19 апр 2024
- hahaha this system sucks.
a huge thanks to my Patreon for giving me a chance to do this way-too-big video: / briandavidgilbert
filmed by Karen Han: / karenyhan
music by Louie Zong, check out the album "Business": louiezong.bandcamp.com/
MERCH: store.dftba.com/collections/b...
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WEBSITE: www.briandavidgilbert.com/
Looking to get involved in healthcare reform? Check for any state/local groups or groups in your profession (especially if you are a nurse/doctor/medical student!) to join or support! Here's a relatively comprehensive Wiki page on U.S. Healthcare Reform Advocacy Groups to give you starting point: en.wikipedia.org/wiki/List_of...
ARTICLES REFERENCED IN THE VIDEO:
- "Brian David Gilbert Begins Comprehensive Deep Dive Into How to Get Health Insurance Now": hard-drive.net/brian-david-gi...
- "FORMULARY (LIST OF COVERED DRUGS) FOR BLUE SHIELD OF CALIFORNIA MEDICARE PLANS": www.blueshieldca.com/bsca/bsc...
- "Analysis: Half of Emergency Ambulance Rides Lead to Out-of-Network Bills for Privately Insured Patients": www.kff.org/health-costs/pres...
- "Can Hospitals Use an Out-of-Network Anesthesiologist or Physician?": www.ushealthgroup.com/2021/04...
- "What Medicare Covers": www.medicare.gov/what-medicar...
- "Nebraska Medicare Eligibility": dhhs.ne.gov/Pages/Medicaid-El...
- "Millions of kids qualify for Medicaid. Biden funds outreach to boost enrollment": www.npr.org/sections/health-s...
- "Open Secrets: Client Profile: Blue Cross/Blue Shield": www.opensecrets.org/federal-l...
SECTIONS:
00:00 - Intro
01:52 - Health Insurance
02:53 - Dental & Vision Insurance
03:42 - Premium
04:19 - Deductible
07:08 - Copays & Coinsurance, Out-of-Pocket Maximum
09:58 - Drug Tiers, Drug Formulary
11:53 - Open Enrollment, Qualifying Life Event, COBRA, Special Enrollment Period
14:40 - In-Network, Out-of-Network, Multi-Tier Network
17:03 - HMO, PPO, EPO, POS Plans
19:08 - HSA, FSA, MSA, HRA
22:14 - Medicare & Medicaid
25:19 - Obfuscation
27:02 - So... what now?
29:19 - Credits 
Приколы
An IMPORTANT update on emergency medical treatment! I've had a few people point out the "No Surprises Act" which was passed this year: www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills
Now, if you have health insurance, this act will "Ban surprise bills for most emergency services, even if you get them out-of-network and without approval beforehand (prior authorization)." This is super good news, and it means that you shouldn't be afraid of calling 911 in a medical emergency-you'll still have to pay for it (like an in-network procedure), but it won't be completely out of pocket if you go to an out-of-network hospital. The act will also "Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections..." and though I'm less convinced about the "easy-to-understand" aspect, at the very least it means you SHOULD be notified about this when you receive the bill!
radiohead
NSA was great, but also worth a shout out to the Transparency in Coverage regulation. Idealistically will also mean that you should be able to get an (at least approximate) rate from your health insurance provider for a given service.
Also REMEMBER EVERYONE:
*If you have a procedure done that you are told is going to be covered and then when you get there to pay, they have an OUT-Of-NETWORK company give you Anesthesia but they never told you they weren't in-network & make you pay $2,380 for it, MAKE A COMPLAINT/APPEAL for it because not telling your patients about an additional out-of-network cost that's also being done is ILLEGAL.*
Because this is against the law, your insurance company will APPROVE your Appeal and the doctor's office who you paid will have to PAY YOU BACK THAT MONEY.
Get your money back!!! Don't overpay or let doctors get away with ILLEGAL shit like this!!
I just had it happen to me TWICE so they're having to pay ME back over $3,000.
Yo, my current job is in a department that *enforces* the rules of the No Surprises Act! 😁 This "no-choice" loophole was a thorn in my side for *years* because it was "technically" legal. Now I get to call bullsh*t on their billing practices with the federal government to back me up, and save regular people from getting billed for things completely out of their control.
To elaborate, the "easy-to-understand" requirement includes - most importantly - a price estimate of the cost of the services you will be receiving voluntarily by providers who are out of your insurance network. You must be given this paperwork at least 72 hours before the expected procedure - if you weren't given the papers, then it's on them to explain why, not you. It also protects you from hospitals contracting out their labs/radiology/anesthesia to third party companies that stay out of network because they know people have no choice. (There's one company in particular that provided *neonatal care* that stayed out of network to take advantage of this loophole. That's right, *preying on families with newborns.* I'm SO glad they're finally facing consequences.)
As an outsider, this feels like the worlds greatest legal scam.
It is.
It is. The health care industry in America is a scam on top of a scam on top of a scam.
It's the SECOND greatest legal scam. The number one spot goes to student loans. But they often work in tandem to destroy people's lives (like mine).
Yes💀
@@vulpinemachine Tell me about it. I'm going to a 200k dollar uni (my dumbass thought it was 50k because they never said that amount was per year on their website and I trusted them on that figure, stupid me) and while the president is getting a key to the city and spending 22 million on a football stadium, the music building literally has fucking asbestos in the noise cancelling panels on the walls and one of the dorm halls has a mold problem, the asbestos being a completely open secret and the mold issue being an open fact.
The goal was never to make your life better. It's to give you the illusion that your life is better or will be better down the line
Seeing this as an American in my early 20s is like walking down a long, dark, narrow corridor and seeing a text prompt telling me to hold Shift to sprint.
I don't usually leave comments like this, but this is genuinely one of the funniest and most encompassing descriptions I've ever heard for being an early 20-something. Thanks for the laugh and existential dread lol.
LMFAOOO
Is this a Sister Location reference? 💀
@@vitorpinho3290 idk i havent played it lol
@@vitorpinho3290 no but sister location is one of the many games that does this
I got charged for watching this video by my health insuarance. Apparently, Brian is an out-of-network consultant and I didnt get him approved beforehand as a specialist by my PCP. Now I'm broke! Thanks Insurance!
Things have gotten to a point where this could be true
😂😂😂😂😂😂😂😂😂😂
Too funny!! Doing research on all of this and it seems the affordable health care act and the government and IRS and people running it..have been banking. They have been receiving $6400 a month or more .. definetly $300 a week for EVERYONE with a social security number! And GOD knows how long this has been going on for..and to just think only a handful of people have actually "applied" to recieve there entitled benefits. Seems super shady and a way to line the government's pockets. Investigation is continuing and hopefully EVERYONE will be informed of the TRUTH very soon.
mood
Ahhhh omg that's funny but not funny people go through that same situation every damn day because of stupid insurance rules
As a recent US immigrant, After getting health insurance that my job pays for, I decided to have my issues looked up. I started with tinnitus which was keeping me up at night. I made sure to go to a clinic that was "in-network". They tested my hearing and there were no issues and I didn't have to pay for any of it. So far so good. But then they suggested that the issue might be brain related and could be serious. So they directed me to another clinic in the same building to get a brain scan where I got scheduled. Little did I realize that the second clinic wasn't in network, so imagine my shock when I received a 1,500$ bill on my way out. Good news is, they didn't find anything wrong with my brain...
This experience destroyed my willingness to get my issues checked out and my trust in the medical industry in general. Although I have many concerning issues with my body, I'd much rather take the risk of death than ruining my family's financial stability. And I have a sneaking suspicion that this is exactly what this system is engineered to do.
Lying until proven sickly
Yep.
If I were to say what I think should happen to the CEO's of the health insurance industry, I would be physiclly removed from this website.
Of course it is on purpose, they make seeking help so troublesome so people do it as little as possible so they can get that premium every month without offering a service.
I find it more mind-blowing that people, like yourself, prefer the chance of death over an insane hospital bill....I had friends just let me lay on their floor after a seizure during a hangout night (had too much beer as a diabetic) only because they thought my health insurance wouldn't cover the ER room. But they were sure to say how scared they were for my life....If I'm dead, I will have no bills anyway. JESUS CHRIST THIS COUNTRY IS INSANE!
@AssBlasster that's the thing, they fucking don't.
That's not what OP is saying, that's not what people in the US are saying. Most people want single payer. But the health industry lobbyists don't.
The developers really dedicated a lot of time into the worldbuilding of this dystopia. I'm beyond impressed.
I mean they wrote the code for their maximum gain. The question is why we allowed them to. Seems like a functioning democracy should have stopped such a disgusting predatory system. Yet support for public healthcare in the US is only around 50%.
I know and the game is so emersive! Hey, by the way, do you have any tips of turning it off?
A great amount of drugs and a gun gets you a secret ending tbh
Alternatively, being reckless or unlucky also nets you another secret ending as well.
@@chazdomingo475 Wanna know another funny little trick Politicians don't want you to know? Being a politician with money causes your vote to all of a sudden carry a lot more weight than if you were broke.
Can't wait for this to be the unironic insurance guide that everyone grows up with
Hey nice name
lord knows public schools aren't stepping up
This is better than my works training
@@Weckacore no u.
No jokes, it took me 2 of the past 3 years working in specialty pharmacy to get all this.
As an ER doctor, that's true, we're often private contractors. Which also means I don't get health insurance through work. Which blows and also screws patients over because the middleman who staffs the ED is often out of network. Oh, and did you know that insurance companies can completely change what drugs are covered by their formulary anytime of the year? and that doesn't count as a qualifying life event? Wait is our medical system... Irretrievably... Broken?
Wtf doctors dont get health insurance....what a weird concept. it should be universal healthcare for doctors/nurses/other medical profs doing the work for our health care system!
Bruh wtf do the doctors do when they don't have insurance?
@@Superboologan1 I'd assume that doctors have a good enough salary to be able to afford private healthcare and costs of out-of-network care, but at worst, the same thing that everyone else does when they don't have medical help. They die.
> is a doctor
> can't get health insurance from job
> doctor can't afford to go to the doctor
Conclusion: We are living in hell
the american health care system was made to make money and not spend it.., thats what america is about.. making money as much as possible and making sure to not lose any... at any cost..
One of my core memories is my mom being locked in the office on the phone like a full time job for several days because our insurance got bought out and they stopped covering ALL of my sister’s medical costs. Eye exams, tests, PCP appointments, EVERYTHING. After a LITERAL WEEK of being transferred , gathering documents, getting corporate phone numbers, she finally found out why: my sister was receiving health insurance from her two full time jobs which excluded her from the family plan. MY SISTER WAS 8. The best part is you have to confirm the patients name and DOB to access any information.
They eventually got slammed with a fee (that was definitely way less than they made from charging people who didn’t have the knowledge or time to fight this battle) in a lawsuit. Turns out in the data transfer they purposely lost or altered data to shit like “grade schooler has 2 full time jobs” to siphon money out of people in the confusion and then use the confusion and unnavigability of a new system as a smoke screen.
I love it here.
Btw if you know you are being charged unfairly DO NOT PAY. You should have a grace period to pay so that gives you time to fight back. Otherwise they’ll go “oh yeah there was a mistake but it looks like the bills already settled so that’s great!” And now you’re out $15000 and filing for bankruptcy. :/
@@Lorraine202I just learned this. My insurance company has been increasing the amount listed as what I owe for months even though the actual HCP’s costs were settled. Double check before paying anything to these vultures.
As a psychiatrist the part when you removed "Mental" from the definition made me laugh while crying tears of rage on the inside
APAB
So who pays for mental healthcare?
Do you have to get special insurance?
@@Jehty21 the short answer is no every insurance is supposed to cover it. In practice many insurers have major caveats in their coverage regarding mental health fueled by the intrinsically subjective nature of such reports. For example I can take your blood pressure and objectively report to insurance that it's too high so you need corrective meds. But if you have depression there's no lab test, I am fully reliant on your reported symptoms to make a diagnosis and prescribe treatment. And if BDGs video was any indication it gets even more complicated when you start talking covered meds or therapy.
@@Jehty21 in most cases folks just don't seek it.
@@ohnoagremlin And are then surprised by the disproportionately large amount of mental health issues in our nation. Yup, the system's clearly working as intended, folks!
I'm a 32 year old professional and this is the most time anyone has ever dedicated to explaining health insurance to me.
Yo, same. I learned the hard way that even if you have a life change that qualities you to get health insurance at a different time, you still might not be able to get it. In Massachusetts if you don’t have health insurance for three months, you get dinged on your taxes and I ALMOST hit that, luckily my employer helped me out and I got my plan sooner than later. I fucking hate this system.
You basically need an equivalent of a lawyer for healthcare. During the ACA transition, some states wanted to block advocacy services that guide people through this insanity.
@here is the full clip stop spamming
Ah yes, Nebraska, who found it useful to specify that medicaid is available for people:
- 18 or younger
- Between 19 and 64
- 65 or older
The funny thing is the only reason the private health system is results oriented is the money whereas the public one a person is able to float around in a malaise with no resolution
Is this accurate? Because the way you phrased it means 19 and 64 year olds don't qualify.
@@CMoore-Gaming I think "Between 19 and 64" includes ages 19 and 64.
I don't know why Nebraska would have a law banning two specific ages from medicaid.
@@4thaltThe vibes are off I guess?
This should play on repeat in every waiting room in every doctors office that accepts insurance.
Play this _in_ the insurance offices when you want to make a claim. Remember that scene in The Incredibles when Bob tells a client how to get her claim approved? That should be mandatory. People deserve to know how to benefit from their insurance.
AGREED!! ***ESPECIALLY*** before and during open enrollment.
30 minutes of Brian explaining manmade capitalistic horrors beyond our comprehension
ok
The one time "beyond our comprehension" is not a meme. Jesus fucking christ
@@duongchuc1834 👀 ok
Surprisingly informative
So what you're saying is Unraveled is back?
I cant believe that Brian just tricked me, a 21 year old who is nervously gripping onto their parents health insurance, into learning about how to navigate getting my own healthcare. You’re doing to lords work Brian.
I love your picture
I am being sincere here when I say this: Start leaning now. Seriously. This shit is intentionally overly complicated, and it changes a little in ways that are hard for us plebs to understand year after year. New laws are coming out all the time that allow insurance companies to get away with literal murder. Fun fact, did you know that failure to provide aid as a professional in the event of an emergency is actually classified as a form of murder through negligence in some states? Well, insurance companies sure do, so they made damn sure those laws have loop holes in them that excuse them from ever having to pay for potentially life saving procedures that hospitals will refuse to even attempt unless you can guarantee payment in advance! YAY!
Well….can’t you have it for 6 more years?
@just i c e stop spamming
@@EricLS 3 to 4, depending on when her birthday is. It drops when you turn 25.
People are absolutely trying to push private health care up here in Canada. It's disgusting
US healthcare: "That'll be $30,000."
Canadian healthcare: "Have you considered suicide?"
That's why ya go Union.
Not only is my health care accepted in EVERY hospital, Emergency Care, and back water hellhole, BUT I pay 500 bucks, and then it's covered 100%.
No premiums as it's covered by the work we do.
AND my insurance will never deny me, if I get some random rare illness my insurance goes, "Do whatever it takes to keep this man alive".
This is the same for my dental and vision insurance too (except vision is always 100% covered no matter what, up to Lasik and Eye Surgery at which point i'd need 500, then it's covered).
That’s my dad! Woooo
This is kind of a misleading talking point that you're repeating. Canada has always had private-sector primary care. So called "private healthcare" proposals such as the one by Premier Ford of Ontario involve expanding the existing public insurance system to cover treatment provided by private-sector hospitals and specialist practices which is where Canada is seeing it's most rapid increases in wait times. The provincial insurance providers (which is the mechanism that protects Canadians from having to pay out-of-pocket costs for treatment) would remain in tact, to propose privatizing the insurance system as is the case in the US would truly be worthy of outrage
@@pewp_tickalar This is such a garbage opinion, the wait times are not the problem. The Ford government has cut funding for the healthcare system every single year that they have been in office.
The idea that some people look at this and think “the system is working” makes me question their grip on reality.
Well... It is working. You just have to redefine "whom" it's working for. And that's definitely not anyone who is sick. Rich people get sick, they either are so rich they don't care or they blow through a ton of cash because they have sooooo much money that it really doesn't matter. If you don't believe me, google Sumner Redstone's net worth in 2014 and his net worth in 2020.
They don't care because they have the money to cover medical bills or they have someone else do this stuff for them. My uncle is one of those people.
Propaganda is an extremely powerful force
I have been diabetic for 30 years (since I was a kid) and let me tell you.. navigating the nightmare that is the American Healthcare system for my entire life has been soul crushing. It's worse than the fucking disease.
TRUE
Same my guy. It suuuucccckkkkkssss
I will never forget hearing my 20 year old brother sobbing on the phone trying to get his diabetic supplies shipped to him after days of calling and hours on hold and after nearly a month of having no method of testing his glucose levels. To this day it makes my blood boil.
Not trying to be funny but I have a question, why not just leave America? For real, it's a shit hole, have you considered moving to a place with free healthcare?
its weird to see that, im in a 3° world country and diabetic supplies are free here, i mean, the right of life dont apply to this situation?
Funnily enough, this is the most horrific video BDG has ever made.
One of those reasons that keep me faaar away from the USA. I don't even have to deal with this and it still stresses me the hell out
Yeah. It's crazy to think that people have actually died because of this
So rich people can make more money. Real people are actually dead
LITERALLY THOUGHHHH
@i better call stop spamming
@@danielblank9917 bro it's a bot
I’m a chronically ill 18 year old American. Im on my parents insurance still (it’s Medicaid but STILL) and cannot get a job because if I do my parents will lose their insurance!
Once im kicked off then I’ll need to find a job that either covers all the medical needs I have OR get Medicaid myself.
I came here and learned a lot of insurance terms that I never knew so I appreciate that.
It’s terrifying being ill in America. You can’t afford to live even when you’re HEALTHY let alone when your body wants to kill you or make your life a living hell constantly.
Oh and god forbid you have a rare illness because then doctors don’t believe you and you’re laughed at, yelled at, and told “it’s all in your head”! I almost died last year and was just barely diagnosed with the very same thing that I told my doctor I suspected due to it being a common occurrence in people with the same other chronic illnesses I have.
We’re all fucked over here please help me.
Feeling that man. Definitely can relate there. Went through some chronic illness troubles in my teen years and was not listened to.
I am so sorry. Moving must be unimaginable at this circumstance, but I can’t think of anything else other than moving to another country that is not a complete dystopia.
22 year-old with Ulcerative Colitis here. It's $10,000 for a bottle of 30 pills that will keep my stomach "normal" but weaken my immune system to the point where a basic head cold could probably kill me.
My mom lost her job, which provided her with our health insurance and over half of our household income, when they suddenly got a stick up their ass about her performance. Now we can barely afford our basic needs on top of my mom and I both having so many medical conditions we can barely function on a daily basis and now we can't afford to have any of them treated. We've spent the past year since she lost her job flipping through so many insurance companies that have severely overcharged and underprovided or just outright lied to us. I get sicker by the day and can't do a single thing about it. And now I'm getting to the point where I'm fearful of whether or not I can hold the part-time job I have because my condition puts me out of work so often.
God is good, but a lot of humans down here are shit, and I can tell there were some pretty shitty ones making the decisions regarding our Healthcare system.
@casquinhaS2 On that point, most countries ban disabled immigrants….
ough I'm so sorry, wishing you eased pain and a support/solidarity system within this hellscape.
I've heard a lot of people talk about getting a big hospital bill, asking for an itemised bill, and discovering that about half of the cost is for procedures they didn't even recieve.
Its always recommended to get an itemized bill to avoid problems like these. Knowing health insurances, they’d probably charge a fee to get it sooner or lager.
Glad to see BDG is sticking to his roots and still making horror videos
This is even scarier cus everyone in the US has to deal with this.
the worst kind of horror is the things that CAN hurt you
This is genuinely the most terrifying thing Brian has ever posted, nothing is scarier than the American healthcare system.
Send help
Except, quite possibly, the American Tax System, which is just as confusing, and carries criminal charges if you don't do it correctly
'The IRS' has entered the chat
North American gun laws and gun culture are also quite scary.
At least they can't calculate your HP yet
I live in India and got glasses at the age of 12. My myopia has cost us a net total of around $100 over the past six years, including three changes of frame style, six prescriptions, and yearly checkups at an ophthalmo. This is after zero government subsidies or aid.
American people have no goshdarn clue how much corporates are ripping them off about the price of healthcare.
No we know, there's nothing we can do. The people in office that are supposed to look after our well being are incentivized by healthcare providers to do the exact opposite. This country needs to change it's voting system and something could change, but nothing will change because the people in control are making money.
Most of us are extremely aware of it, but we have virtually no control over our government.
@@Zanadorsomething like 33% of eligible voters don’t vote.
@@joeschmo4646 Yes, and that is a problem, but it's far from the only problem and not the most impactful one IMO. Getting corporate money out of politics, getting rid of first-past-the-post elections, and getting rid of the Electoral College would all have a much more noticeable effect than higher turnout. We could also think about making the House proportional again (removing the limit on number of members) and making it harder for the Senate Majority Leader to unilaterally control what gets voted on.
The problem with all of these reforms (including any change that would actually increase voter turnout in a consistent way like compulsory voting) is that they would need to go through the legislature. We can't change the system unless the people running the system allows it. Most politicians aren't interested in reducing their own power, or making it easier to get voted out, so these reforms go nowhere.
@@joeschmo4646 American politics only ever gets two final choices to pick from. Even if that 33% of more people voted for a new independent group, they'd still lose by about 5% against the original split 77%... (And this is ignoring the representative/gerrymandered side of the "democratic republic.")
The bipartisan system that doesn't allow tiers or multiple choices is inherently flawed, stacked against the citizens.
I used to work in a billing office for a multi-hospital Healthcare company and it was really radicalizing. Medicare for All is just the beginning of what we need.
i’m on the edge of my seat for this video to devolve into horror
the true horror is the system itself
@@briandavidgilbert As well as the fact that there are people who think this is a good thing
@@samlevy9897 YES
HH : healthcare horror
@@briandavidgilbert the real horror was the friends we made along the way
honestly, BDG pivoting into edutainment was not something I expected, but I'm all for it.
I dunno it definitely has an “unraveled” vibe which I have sorely missed, I just wish the topic wasn’t so rl horrifying.
@@MrPiptron *laughs in Britishness*.
did you forget the second part of the complete pokerap? for shame
@@MrPiptron Unravel is definitely edutainment.
Pivoting? Unraveled was very edutainment
You know this makes me happy to live in a country with universal healthcare. I've been worrying for a couple of months bc i need to get a cronic illness diagnosed and my thoughts have been "man what if this test can't be done by public healthcare and I'll actually have to pay like 20€" watching this video REALLY puts it in perspective
I remember being SO confused when my dad told me to start deciding a health insurance plan at 18. I tried for an hour, just gave up, and somehow lived through it being off-and-on of my dad's insurance. I'm having to relook at this crap again (you were an immense help!) after a sudden "reduce in force" by my employer and to pay out of pocket....can't go without while I'm a type 1 diabetic FML
Can I just say
1) this feels like a real return to form for fans of Unraveled
2) this really demonstrates that some creators are such that their audience will listen to them talk about literally ANYTHING and trust it to be entertaining
I feel like I somewhat agree with number one
As for number two Brian could read the dictionary and make it interesting
I almost didn't watch it because based on the title I thought it would be boring, but I decided to trust BDG.
honestly as an european in a non english speaking country this is absolutely useless... but bdg makes it entertaining
I'm a chronically ill American, so this is really just as relevant to my interests as Unraveled, unfortunately.
@@cygnahoshiko4629 Yeah, I'm going to grad school next year and I'm chronically ill too so I also really needed to know it. New insurance + new place + being independent to deal with my own insurance stuff. I just realized how complicated this is all going to be next year while I was watching the video.
It's honestly crazy how Brian comes up with these weird existential nightmare scenarios... Like could you imagine if that's how health insurance really worked? That would be terrifying!
🤣🤣🤣
Ha ha! Even just thinking about the existential crisis I would have over this totally nonexistent system is killing me! And I wouldn't be able to afford the medicine that would save me! 😂
Soooooo damn glad I'm German right now.
You go to whichever doctor you like, let them do whatever they want, and never even see the bill for the treatment.
Also REMEMBER EVERYONE:
*If you have a procedure done that you are told is going to be covered and then when you get there to pay, they have an OUT-Of-NETWORK company give you Anesthesia but they never told you they weren't in-network & make you pay $2,380 for it, MAKE A COMPLAINT/APPEAL for it because not telling your patients about an additional out-of-network cost that's also being done is ILLEGAL.*
Because this is against the law, your insurance company will APPROVE your Appeal and the doctor's office who you paid will have to PAY YOU BACK THAT MONEY.
Get your money back!!! Don't overpay or let doctors get away with ILLEGAL shit like this!!
I just had it happen to me TWICE so they're having to pay ME back over $3,000.
@@emilytada455 Same in Canada! And I’m thankful for it.
I once watched EMTs debate which hospital they should take a patient to because they couldn’t remember which hospital was in what network, while the man held his own head wound closed. That’s when I realized I might want to leave the country…
…and then I did. Never have to deal with this crap in Canada 🇨🇦
Canada will try to push this system on its own citizens eventually... capitalism always leads to late stage capitalism
i recently had to take an ambulance ride, its AMAZING how much they charge you for STUPID THINGS, like it was over a thousand dollars to be taken by ambulance LESS THAN FIVE MILES, (after seeing my bill, i looked it up, and found out i was LUCKY as someone not that far from me, was charged OVER EIGHT THOUSAND DOLLARS for a similar ambulance ride.) and of that, there were some CRAZY fees, like an almost $200 service charge.....because they used their radio, there was also a $100 fee because they turned the sirens and lights on....NOT EVEN JOKING...
I think BDG may have found his true calling: making adulting PSAs. I can't even imagine how helpful this would have been if my high school had shown me this video 15 years ago. Please make this a series.
I'd love to see him collab with Hank and John Green (vlogbrothers duo) to remake their How To Adult series
@@purplegill10 YEAHHHHHHHHHHH
get that complexly funding bdg!!!!!!!!!!!!
Honestly I would really like more videos of him explaining stuff like this
Like maybe he could help explain taxes next, that'd be really nice
Adulting step one: if you say adulting you are neurodivergent and your needs are fundamentally different from every other person the system is created to accommodate and you never will be accommodated by said system. you must find solice and support within compasionate friends because you never will find solice or support through any system where money changes hands. The best you will ever do is learn to scrape by to be able to find more moments where you can be with people you trust.
As an Australian, this comes off as a psychological horror video.
Please don't take my Medicare away from me.
you CANT let them take it away
Yoink 🏥
Don't let them take it away from you, you can't understand how bad it is until you've lived through it, you can't let it happen, any politician even flirting with expanding private healthcare to the detriment of public healthcare should be understood for what they are, a life ending human-sized parasite determined to suck the blood out of you and every one of your loved ones until they're nothing more than dust. You are privileged if they are crushed under heel like such voracious parasites should be, however, barring that, do your damndest to keep them away from any kind of civil service. They will destroy anything good.
They have tried to several times, and they tried to do the same with tertiary education. Very scary times. So glad we still have higher taxes and better benefits 👍
@@The_Cyber_System ill bet 10-1 odds your "higher taxes" are less than what most Americans pay for private insurance.
Okay you call the guide terrible but this is actually a really excellent guide. I'm a whole-ass pharmacy technician, dealing with insurance bullshit is part of my job, and there's stuff in here I didn't know and I will 100% be copping some of your wording.
my parents' had medicaid growing up, and because of this and the state we lived in, i became uninsured at the very adult age of 19. yep, some places in our country literally expect 19 year olds to be able to afford their own insurance. i now owe over 50k in medical bills due to one severe emergency that happened in the 5 years i was uninsured. i now have a job with "benefits" which means i pay hundreds of dollars a month for insurance so i can go to the doctor now. except, ya know, every time i go to the doctor, i still have to pay hundreds of more dollars, even thousands of dollars, out of my own pocket every visit bc my insurance wants to cover basically nothing and they also think teeth are luxury bones.
And I LOVE how some Americans say, "Well I've got freedom of choice", when they don't really have any choice. The CEO where they work picks what insurance company their company offers and he picks the two (or three) plans that are offered. If you don't like the insurance company he picked, you are 100% on your own.
I will now refer to my teeth as luxury bones. This is your fault
Reminder, people of Europe. THIS is what “privatized healthcare” means.
We have this in the Netherlands too, so europe, sadly, knows
@@jakobvanklinken Yeah ... no. Sure we have copays but don't pretend like we get insane pricings and holes in our coverage like in the US. Sure if you go to a specialist which isn't in basic insurance such as physical therapy you'll have to pay it yourself. But that's only if you don't have a certain chronic issue which requires you to go. And if you are in an emergency situation 'network' doesn't mean anything. And if it is 'out of network' you usually only pay about 10-30% of the full price.
In a country as small as the Netherlands and like I said earlier ignoring emergency situations which don't apply there is basically no reason to go out of network in the Netherlands. Where American companies have those systems in place mostly for monetary gain, Dutch insurance companies have it in place to stop people from hopping from doctor to doctor, clogging up systems with inefficiency.
The Netherlands has far from a perfect system. But it's harmful to the existing system and the people fighting for universal healthcare to state that the system in place in the Netherlands is anywhere near the system of the US.
And South America
Ok
If by private you mean heavily regulated at state and federal levels
As a Canadian that moved to the US for work, it was maddening trying to understand why people don't riot because of this. There is literally a whole private insurance industry and departments in hospitals dedicated to just dealing with billing. It wastes so much money.
That's the point. It wastes your money, but someone is getting rich off it.
I always thought it was hilarious that conservatives try to claim private healthcare is cheaper and more efficient. I'm no fan of wading through the swamp of government bureaucracy, but I'd take it any day over corporate bureaucracy that charges me a cover fee just to get into the bog.
'cause it's just normal for them, a lot of people think without it healthcare is worse in other countries, when it really really isn't, or that it has insane waiting times, when it doesn't, (and that one's always been insane 'cause their waiting times... Aren't good?) it's hard to see a different world without ever experiencing it.
Especially with all the money that goes into preserving the fuckitude that the system is.
It makes me so glad to be British. 'Cause we do know what it's like, and there would absolutely be riots across the country if our system became like theirs.
And it's larger than the department dedicated to just dealing with patients. Inside of a hospital, you ONLY see the tip of the iceberg, but every level between insurance and providers have to fund their own department dedicated to fighting the other parties on coverage and billing decisions. At a hospital, your doctor is conscripted into this effort with excessive charting requirements and justification checks and outside reviews that may cost them more time than actual patient care.
@@MagicCardboardBox our system absolutely will become like theirs within the next decade, so I hope you’re ready to crack some skulls when it does
I think a key thing you should have mentioned is just how difficult it is for low-income people or even retired old people to even get Medicaid and Medicare in the first place. The requirements are very stringent and require you to relinquish any amount of money you have to even qualify for these programs. If you make $1 too much over the limit, you are automatically disqualified. It's a subtle and sinister caveat.
I work for a health insurance company, and I am strongly considering showing this video to my new hire class to help them understand this insanity. Definitely a broken system
I love the argument of "Well it's either this or you wait for hours in the ER" when we literally all have to wait for hours in the ER
Or the classic "it's either this or increased taxes! Do you really want more taxes?" as if the increased taxes will somehow be more expensive for the individual than the thousands of dollars people are forced to spend on healthcare.
@@creeperhunterD [2 buttons meme:] [option 1: pay like 1% higher taxes and live worry-free] [option 2: pay a completely unpredictable amount for health care and have to navigate medical bureaucracy every time you have an unexpected medical situation]
It's just so hard to choose!
I had a recent hospital stay where I literally waited for 9 hours in the ER, and I have good health insurance.
And don't get me started on the "it's the cost of the best healthcare in the world" bullshit.
torries complaining about having to wait months to see a specialist while i, an american, couldn't even get a referral for my obvious chronic illness until after i developed permanent damage to my spine...and then i STILL have to wait half a year for my initial appointment with a specialist!
(not saying the british healthcare system doesn't need improving, but privatizing the industry is a massive step in the wrong direction. fight for your public healthcare tooth and nail.)
It's awfully convenient how health care doesn't cover psychological damage given that the structure of this system causes me the most psychological anguish
Insurance also fairly regularly reaches the top of the most depressing jobs in the US
i live in Europe so watching this made me nauseous. I actually feel sick listening to it
Our waiting times for healthcare are basically non existent so no waitlist AND as a bonus we can own semi automatic rifles and Europeans can’t.
@@theorderofthepurplephoenix3321ngl owning a weapon that is specifically designed to kill as many people as possible in a short time span doesn’t seem too appealing
@@tapwater4425 having the proper means to defend yourself and your home is something Europeans can’t do. If people break into your house you will have free healthcare when they injure you, but you won’t be able to defend yourself, you’re family, or your valuables
@@theorderofthepurplephoenix3321 there are ways of defending yourself aside from guns, like a baseball bat, or a knife.
Besides, I do see some benefit to having a gun *if* the attacker also has a gun, but automatic weapons are a bit overkill and usually cause more harm than good.
@@tapwater4425 first of all, a bat or knife while not stop a group of people. Secondly, a knife or a bat is a much more brutal way to kill someone than a gun. And lastly, regular people aren’t allowed to own automatic weapons. To own a automatic weapon you either have to go a long and tedious background check and pay 50-120 grand or go through a almost impossible amount of paperwork to get an ffl. Felons, and people with a record of violent crimes are not allowed to own any guns. Automatic weapons are really only for the most diehard of rich gun collectors, a very niche market. Many robberies have been stopped by store owners/civilians who had guns and many live have been saved by guns. In America we do not have a gun crisis, we have a mental health crisis and not enough background checks for certain guns
As an Australian I was like, just go to hospital bro, its all free! And then I was like, I am sorry your country sucks so much 😢
I'm so upset this came out AFTER I had to learn all this myself LMAO
just come to canada bro
YOOOOO ITS CIRCLE
I’m one of the first ppl to respond to this
Same lol
Don’t worry, all the rules will change the moment any of us actually understand them. Isn’t this the best system ever?
So, I have a friend with a chronic disease that was working in the States for a couple of months, and when he needed prescription drugs, he found it more convenient to fly back to Europe, go to the doctor, get the drugs and return. Not just in terms of money, because it was also cheaper to do so, but that way he didn't have to wrestle between several companies so he could get his damn drugs.
Literally what I do too, and I've lived in the US for four years now and have insurance. Even though I don't have my German insurance anymore and have to pay out of pocket, it's much cheaper to fly home and go see my old providers there every year or two. Especially women's health services in the US are sub-par compared to the rest of the world (it's basically just a manual exam and pap-smear in the US, where in other countries they're also checking everything via ultrasound, which makes much more sense). It's ridiculous.
It can be cheaper to fly to Mexico, have a vacation, get dental surgery, then go back by the time you can even get scheduled for one in the US
Even with dental insurance
@@genderender Yeah but in the US it's done by doctors with dental tools, pretty sure in Mexico it's done by mechanics with auto tools who have some free time
Wow, Europe sounds like a wonderful place with free and fast drugs, how can I join in? 😃
@@testname4464 doesn’t seem like a racist statement at all
I haven't been to the doctor or interacted with the medical system here whatsoever since moving to the US (years ago) because I don't understand it, get most things done when I go back home (and I'm young and will never die), and every official website looks like a scam and asks me for my social security number. So thanks Brian. Because of you I might go and see someone now.
I turn 26 in two days, I’ve got like 15 tabs open on my laptop while watching this, and I’m consumed by fear and confusion. 🦅🇺🇸
As someone that's worked in health insurance for 6+ years, I can confirm that *all* of this is correct, and it's exactly as baffling, opaque, and unfair as it sounds. Well done on creating something that gave me flashbacks to the innocent days when I was being onboarded into this nightmare of a system, but had to learn all this through "fun" modules.
you've worked in health insurance????? burn it down from the inside for me, please
@@bunshine Oh, I intend to!! That's part of the reason I've stayed in this industry. I want to work my way up to a point where I can help in the dismantling of the whole thing, with the infrastructure scrapped for parts and used to manage a single-payer system. I've worked in Medicaid AND private plans, I *KNOW* it can be done.
surely you must also know that the lobbying is also used on lowering costs via workplace safety? I get its bad, but from the outside looking in- isnt that largely just the sales dept's and healthcare provider's fault?
I made (nay, mass produced) corporate health benefits explainer videos/modules. I am sorry if you were forced to watch any of them.
@@Gliccit Nope, it's the system that incentivices behavior like that, it's made with the purpose to make the most money, not to help the most people.
A clear memory of mine: Watching my dad argue with the insurance company on the phone, from his hospital bed, battling with cancer
Finally it's here after so long :
ruclips.net/video/mCfYi7634rU/видео.html
Fr
Jesús Christ how do you Americans put up with that, I'm so sorry
@@keqingsimp2174 Because Conservative chumps say, "Socialism bad".
@@keqingsimp2174 some of us don't! we go bankrupt or die!!!
I did an English-Spanish phone interpreting training last year, the job consisted of A LOT of medical/health insurance calls and it would've been AWESOME if they showed us this video
Managing my elderly arthritic mom health insurance made me quit vaping and to start eating healthier. The system is broken by design and I don’t want anything to do with
I love how RUclipsrs in our generation will just organically, randomly, make the critical educational content we need the most effective or memorable way possible.
could you link/name some? this is the only example I've seen of what you're describing
@@toulouse1 I assume it counts enough, I watch some tiktok comps about stuff like leftism and disability info and stuff like that, mainly the ones by “a dude” (that’s their actual channel name /gen) which have some pretty good info in a pretty digestible format!
Oh sure I'll think about the others I've seen sometime. Just remember watching channels I'd know for one thing and then something would come up in their life and they'd make a video to help anyone else (like their subscribers for one) with that potential life scenario. But yeah someone should make a playlist out of them, since they're more watchable and thus easy-to-remember than more bland how-tos.
well exactly. They're filling a vital niche that no one else is. Anyway, Brian's cool.
@@toulouse1 not quite 'critical', but "history of the entire world, i guess" by bill wurtz is a good example of spontaneous really helpful educational videos from someone who normally doesn't make them.
The craziest part of the US Healthcare is that this video is actually good enough to be shown in school...
Finally it's here after so long :
ruclips.net/video/mCfYi7634rU/видео.html
But then how will the government invest millions of dollar into the problem, steal most of the money, spend some money on something real to show as progress and get nothing done so they can justify another investiment to do it again?
Beautiful
it would be great to see this in school
I wish I had seen it in school. Twice.
My ex's family who are multi millionaires right now admitted that they straight up just dont have health insurance since its cheaper to pay out of pocket than pay insurance. Also knew people who quit a high paying job to get medicare(or aid the state one) because it had more coverage than a mid-upper tier insurance and is free.
Anyways Im a dual citizen and go to Japan for all my dental and eye care since its too complicated to find a doctor here on medicare and if i do find them, theyre booked out for several months. I hate America's health system and thats the one major thing that turns me off from staying here long term. Literally back when i was in Guam people went to East/South East Asian countries to get medical care
I had a huge stoke of luck with my work provided health insurance. I understood none of it, and way after signing up for it I moved from full time to part time so I could go to college without losing my mind. Well no one told me that I will lose my healthcare for lack of minimum hours as a result, and I wasn't in a role important enough to check my work email. So one of my rare doctor visits, the lady at the desk told me I have no health insurance. I told her to cancel my appointment and I called my health insurance to ask them what the hell. I got a lady who sat on the phone for OVER AN HOUR explaining to me what different things meant on my previous healthcare plan so I can make an informed decision going forward. She also recommended to me that I don't keep my old plan as it would be expensive to maintain. This women even kept assuring me that I'm gonna be alright. Like dude, no one is asking her to work that hard. I hope she is living her best life.
I had a point to this but got distracted. I'm gonna... I'm gonna go now. Goodbye.
Now that Brian David Gilbert makes explainers, I think we can retire now? -John
I was gonna say, I think this is just Crash Course now?
john green in my bdg video?
Happy Pizzamas everybody ❤
Update: We can't retire we need health insurance. -John
Can you pay your health care providers in pizzamas merch?
You know you're chronically ill when the first five seconds of this video make complete sense to you, both in what the acronyms mean and in why BDG chose them.
Damn some people really are born gamers. Gesundheit
the struggle is real 👨🦽
chronic illness was a very cruel teacher in that I knew everything in this video and mode
yup
Haha, yup! The only reason I wasn't immediately screwed by the system when my illness showed up is because I had my mom who also dealt with chronic illness as a guide.
Honestly dude I did medical billing for a couple years and let me tell you this video is so good and comprehensive
Thanks for putting this out, it was a nice refresher on the Insurance Monster💀
glad to be learning about insurance from the guy who made one of the most emotionally raw stories about fathers and sons of the modern day, and also made pepcorn.
As an American college student, this video is genuinely very helpful. They never teach you any of this stuff but it can be life ruining if you don't know about it.
Its by design. Creating an unnecessarily complicated system then justifies the existence of "experts" (Tax Experts, Insurance Experts, Ect) who can then make money off of people usually not having the time to learn these complicated systems. Its also why none of these systems are ever taught, and if anything is done to try and simplify it, lobbyist groups who represent those "experts" step in to keep the money making scheme going.
@@ThatOneREDScout Information asymmetry is one of the most common ways to capture profits.
OP, the main thing you need to understand is that you live in a society that is trying to trick and trap you at every step. Never trust anyone.
@@chazdomingo475 capitalism moment
@@Artameful sadly. Business moment for sure but especially a capitalism moment
oh don't worry, it's life ruining even if you do know about it.
As a French person, I...I have no words for this-
Our healthcare is already pretty battered, it lacks funding, and there aren't enough doctors in any field anywhere, especially in the countryside, as well as specialists dying out-
But this ? This makes our country look like heaven. What the hell ?!
Its funny that there are americans that defend this terrible system. Literally every other country is better in this.
I can say the same. And I live in Brazil. That's how absurd the healthcare in the US is. VIVA O SUS, CARALHO.
Is it bc you guys didn't finish the job and left Monaco standing after the Revolution?
@@DavideMenezes42 I'm literally in shock rn, i could never imagine that something like going to a doctor could be so complicated in the US. VIVA O SUS PORRA!
First of all, Americans who understand healthcare do indeed look at the French system and think yours is pretty great.
As to how we got here, it’s a historical accident. During World War II, wage controls were put in place to prevent the US economy from spinning out of control. Businesses were not allowed to increase salary by too much.
But if a business can’t raise wages, how can they attract workers? Well, they can offer something else besides money as payment. So they started offering health insurance. And then a little while later, the government started giving tax breaks to companies that offer health insurance.
So now the system is entrenched. Every time someone tries to reform it, businesses rebel. Also, the health insurance companies are not set up to provide good care. They are set up to make money. A lot of the reforms of Obamacare were regulations on premiums, coinsurance, copays, out of pocket maximums, and a bunch of other things. It still wasn’t a fundamental change to the system, but it did make a difference in a lot of places.
I'm not American, so I felt a vague sense of relief during this video that I could see my GP twice a month, specialists every once in a while, trial drugs as needed, get urgent and emergency care, and such without getting billed (that frequently). My provincial government is pushing hard to privatise further, and it scares the shit out of me because I'm disabled, can't work, and depend on government programmes to get money and services. So yeah. Only vague relief.
This video was extremely helpful, partly by sorting out terminology, but mainly because it made me feel like I wasn't crazy for being confused and overwhelmed by the healthcare system when I tried to figure it out on my own
Ah yes. How reasonable to expect a person with a concussion or with terrible wounds to stop their ambulance, doctor, and specialist before treatment and say, "Now, wait just a minute. Are you in my network? If not, would you kindly let my chances of living dwindle and get one who is? Thank you."
Actually this happened to my family. My sister had an injury and we called an ambulance just to waive their help and drive her ourselves to the hospital. We were still billed an insane amount, but it was better than the $2000 for the ride
This is America 🇺🇸
ok
I have yet to meet an insurance where an ambulance is covered. I have decided they are fancy scams on wheels and unless I hit gold or am literally dying I won’t/ can’t use one without going into debilitating debt lmao
@@musemccormack5436 the most depressing part about that is im canadian and when i was young i just went to an adult hospital and they let me take an ambulance for fun, and last year i had an ambulance called for me bc i had a panic attack at the dentist, so i know from being in one they are incredibly *incredibly* useful when in need of one, god americs makes me sad
Working in healthcare, I'd like to add:
Insurance companies will do everything they can to NOT pay a claim. They don't make money at the rates they do without denying claims at every chance they can.
Very much true. My partner has quite a few health issues and whenever her doctor recommends a new medicine, she has to go through a negotiation process of her insurance saying well we don't think you need THAT medicine, how about THIS medicine tho? After that medicine fails to work and the doctor reports that to the insurance, they MIGHT agree to cover the recommended medication. I say might because many times they have you go through several different options first, despite the doctor believing their recommendation is best.
My daughter has chronic migraines and her specialist recommended Botox treatments in parts of her head and neck, which have pretty good success rates and next to no side effects compared to migraine meds which leave her super tired and dizzy and nauseous. Insurance made her go through a month of 3 different medicines before they finally agreed to cover the Botox, which has helped her greatly. It's an extremely frustrating, wasteful system. Perhaps it's because we use government insurance and not private so we generally don't have copays, thank god, but this system just doesn't work well for seemingly anyone.
Sorry for the wall of text, I kinda just poured my frustrated brain out here because it's a constant source of stress living with 2 chronically unwell people that I know deserve better
Had a similar situation in my family. Doctor prescribed a certain medication, but insurance was only willing to pay some tiny percentage of the cost, but would cover 100% of the cost of some other medication that sort of is supposed to do some of the same things, but not exactly. So, had to take the worse medication for a period to prove that it wouldn't work completely before they would cover the prescribed medication.
@@iamjustkiwi That our healthcare system allows (and incentivizes) your treatment to be determined by insurance companies against the doctor's actual suggestions is one of the clearest examples of how fucking broken this shit is.
Exactly why I'm leaving this buzzsaw of an industry. It does nothing but create pressure at all levels, personally and professionally, internally and externally.
@@nikolicious589 good for you, we all deserve better and it can't feel good being a part of this system.
i have several chronic illnesses, so i have to work with my health insurance a LOT. this video has been super helpful for me, i’ve actually watched it two or three times now as a refresher! thank you for putting this info together in a way my gen z, brain fogged self can understand easily :)
Even in-network and out-of-network can be misleadingly easy. An irl example, had to go to a specialist that WAS in-network but the building was out-of-network (which we were not informed of). What was expected to be 70 bucks turned into a $3,000+ bill. BUT BUT BUT- some states have things where if they don't tell you some parts are out-of-network then you can make a claim so you can go back and be like "Uhh, hey you said it would be this but I got charged this because you didn't tell us about a part of your stuff being out-of-network so we aren't paying that." And your state will help settle. Make sure to check with your specific state!
Wonderful video that I will keep forever!
I still can't wrap my head around the fact that a health insurance can just say: "No we won't pay for THIS doctor. Yes, we agree that you broke your leg and needed a cast and pain medication, but it was done by the wrong guy. If Peter had done it we would pay, but we won't pay for Mark!"
Don't forget how the broken leg could be a cosmetic issue and therefore not covered
@@MintyMoron64 No no, This broken leg is a pre-existing condition
if you didn't want to have to pay for your broken leg you should have thought about that before you decided to have legs
@@danhonks6264 but make sure mark doesn't amputate them we won't pay for that
@@MintyMoron64 you bruised your knee badly once before, so a harmed leg is a pre-existing condition
I hate that some dude on the internet was able to go over all this in 30 minutes (and the sad part is, that it's trending) whereas the person in HR couldn't even bother to tell me what all of this meant when I first started working.
Thank you for this, Brian. Not all heroes wear capes.
Congratulations on making it onto the trending page too!
It's not that they didn't bother, they don't want you to understand any of this, that's why it's so convoluted in the first place.
I'm so glad my mom worked in health insurance and could explain everything to me when it was time for me to choose my plan. It's such a scam that there's so many extra little costs, and that some plans don't even cover you fully once you hit your deductible!! I'm enrolled in a German university now, and it was SO weird to not have to wade through different copay levels, deductibles, etc... the public options that I looked at all were the same price and covered the same things. Though I do have to choose doctors who accept public insurance.
To be fair, I'd bet that 90% of HR personnel don't understand Health Insurance themselves, so it's easier to just kind of hand wave it. They should do better, but they likely don't do better for themselves either.
@@LeafMaltieze In a lot of corporations the plans or even providers are changes every 2-3 years. Literally no one can keep up with it. All the training comes directly from the provider. Guess how helpful it is.
And of course, if you do have an expensive thing come up that your insurance is supposed to cover the cost of, they will do everything in their power to avoid paying what they owe. Obfuscation is one of the big tools to do that.
No matter where you gamble, the house must win.
I just had a bone graft and pins put in my broken foot a day ago.
90,000 dollar surgery and a 10 dollar copay.
A month ago I would've been indifferent about my insurance. Super glad to have it now...
I feel like its really an indictment of the system that
1. A somewhat basic explanation takes 30 minutes
2. You really do need to understand all of it to navigate getting insurance or healthcare
He just scratched the surface. All the those times where he says your plan/employer/situation may differ? Yeah, that's all real and there are a thousand exceptions to every item he covered. All of them mean you will end up paying through the nose for healthcare.
Haha 30 minutes? He didn't even explain enough to get started with finding health insurance that's worth your money.
All he explained are absolute basics.
Meh, my process for picking health insurance was basically finding the lowest combined annual premium+out of pocket maximum. I understand the rest but ultimately didn't need it.
@@ghosthunter0950 That's... literally what OP said
I would totally watch a series called "Adulting" by BDG that dives in or gives an overview of all the bs the world doesn't teach you enough about until it's too late.
I desperately need info on taxes. Like, every year, I spend months trying to figure this shit out and I have no idea. There's no help for people with learning disabilities like me, and I can't afford a tax service again this year, so I'm already shitting myself.
I couldn't get through it without encouraging fight club
This would be incredible. I definitely trust him to learn the things I'm to dumb to figure out and teach them to me via entertaining videos
taxes would be very good
I mean this is a specifically US problem, same goes for taxes
As someone who’s worked in this field for 6 years and still learns terminology while running VOB’s I truly appreciate this video. This is such a great video I’m going to send it to new hires. Thank you.
I just want to thank you for doing closed captions and not using auto generated captions, very few people take the time to do it and I want to thank you for that.
For all those wondering if this is actually a 30 minute video on heath insurance or if it devolves into horror, just know: this video made me cry
So it’s a 30 minute video on health insurance. Thanks for sharing
o-oh...
So it sticks with talking about health insurance the whole time - good to know!
Its a 30 minute video on health insurance which means its necessarily also about horror
Why can't it be both?
The worst part is that most insurance companies don’t even play by their own convoluted rules and frequently deny coverage that they are contractually obligated to provide. They will make every excuse imaginable to withhold money from you and make zero effort to maintain a positive business relationship with you, their cash cow. The one constant I have seen over the 10 years of having private health insurance with various providers is that you have to fight like hell, for an exorbitant amount of time, to get what you need without bleeding money, as well.
And they're rude too, you call them and put up with their convoluted bullshit for an hour or more and the person on the other end almost always is an asshole, refusing to actually help you or explain things, their job is to suck you dry, not help you, you're just disagreeable food
reminds me of the time i had a procedure that was covered fail, and bcbs tried to charge me almost $300 for that failed procedure. EVEN THO if it had gone right, it wouldve cost me almost nothing at that point bc my family had already met our deductible!!!!!!!!!!
Why on earth would they play by their own rules? If a provider defrauds, say, 1.3 million people a year, how many of those people will realize they've been robbed? How many of the people who realized will be in a position to do something about it? How many of _those_ people will actually manage to get it done? Stealing money from your cash cows is, it turns out, _incredibly profitable and very low-risk._
Legal fees are just another calculated risk, and they are experts at calculating risk. They'll break their contract exactly as much as they calculate they can. The profits they save by denying you coverage are used to pay for the very lawyers that fight against you, the mathematicians that find optimal pathways to screw you, and the politicians that write laws in their favor. Ultimately you are the one funding their efforts against you.
You never had a chance. You don't have teams of mathematicians helping you calculate your risk. You don't have teams of lawyers to make sure your contract is upheld, in which you didn't contribute any of the fine print, let alone half the contract. You don't have politicians in your pocket writing laws for you. You don't have economists keeping an eye on the markets for you.
There is an extreme inequality of every economically important resource, both physical and conceptual, including time, attention, money, law, information, negotiating ability, and even general decision making skills such as game theory. The insurance company counted their win against you as predicted future profits before you were born.
And if I can point out, they may deny coverage for life-threatening conditions that your well-respected oncologist has ordered. You are so right about having to fight hard. Do it early - your private health insurance will likely explain that they are not obligated to provide you any answer sooner than 10 to 14 days; that's a problem when your platelets are low and dropping by 6k a day, but hey, if you bleed out because you bite your tongue, that solves their problem of expensive medical procedures....
The broken system of American healthcare and insurances makes life hell for those of us who suffer from chronic health issues l. Finding doctors is hard, finding clinics that are covered by your insurance is hard, finding medication that is covered by insurance which is essential is hard. It just make us neglect our health and having it to worsen. This country sucks.
America doesnt have a healthcare system, they have a health business
tip from a health insurance agent who hates his job: if your drug list includes tier 3 and up drugs, you can submit a tier reduction request. basically, if your doctor says you can't take the generic/plan-preferred drug a lot of the time the plan has to "price match" your tier 3 drug to a lower tier. it's not always a guarantee but we have a pretty good success rate with getting these requests approved. most people aren't aware that this is a possibility but it could save you a bit of money.
also this video is amazing and made me cackle 😂
+++
Hero
@@sabinajoh In all fairness, in an ideal world, their job wouldn't exist.
thank you friend, i hope you can help as many ppl as possible
I understood nothing of this.
Me, an Australian: "Oh Medicare I know that one!"
Me, an Australian, post-Medicare summary: "Nevermind I have no idea what that is"
My reaction also.
Maybe its different? Idk, all I know is that I have one
Had this same reaction but I'm American
As an American, most Americans have no idea how any of this works.
US Medicare is awful.
Medicaid is usually all free, but usually medicare patients are disabled and/or retired and they often need it more;
*Medicare usually only covers around 80% of medical expenses. Which can be a ton if you have to see any sort of specialist regularly - (pain specialist, immunology doc, etc)
And unfortunately Obamacare made it worse for a while with misleading promises, along with private insurances getting butthurt, and raising premiums and making it harder to reach a deductable(?) with medications (part D).
Benefits I take for granted as a medicaid patient (free doctors visits/no copays/access to more resources like bus passes, free counseling, etc) cost too much for my permanently disabled mom to really do. She’s 60. Im 23 and chronically ill/can’t work right now. Im sad I can’t pay for her to be seen.
Im a doctor in Australia and this hurts my brain.
i’m turning 26 and have to pick my health insurance policy through my employer and this video deadass helped me understand nearly everything on the policy explanation sheets
My favorite part about the deep dives on American healthcare is seeing the horrified reactions of people who aren't from the United States. This is an in depth beginners crash course on health insurance. None of the information presented here is satire, right down to the plans that are referred to as "Part A," "Part B," etc. It's exhausting.
Yeah I'm not from the US and I have to say that this is fucking terrifying
I could never move to there for this reason
I live in a third world country and I get literally EVERYTHING for free. "Oh but queue's must be super long!" I go see a doctor same day if I need to, and I if I have to I can get a doctor home visit (also free).
@@ThoughtsOnThoughts thank you, I swear I have people in my family who are obvious victims of the predatory privatized healthcare and they still go “well at least I only have to wait 3-6 months to even a year to see a doctor instead of however long the queues must be over in places with privatized healthcare!”
Yeah I just show up to the hospital and say "treat me" Done. U wait a little while and u pay nothing or a symbolic value like 5€
@@ThoughtsOnThoughts free? nothing is free my friend. Somebody always has to pay, people have to make the medications, work the hospitals, track the records, etc... payment comes through money or time. The real reason American health insurance is so bad, *aside from the shoddy bureaucracy* is because there is *basically* no upper limit to what the government will pay for different things. So in practice big pharma and hospitals can cooperate to charge exorbitant rates to insured people. Really, Americas insurance problem is deeply rooted in a very large number of other issues, like government money laundering and insider trading, gross government inefficient/malicious spending, outdated laws and systems... When people say they want insurance in the private sector, they don't normally mean completely independent from law, they just want it in businesses with a monetary incentive to do things right, and a minimal degree of government intervention necessary only for keeping the companies from cooperating to jack prices up and to keep insurance payments at a low price for consumers that is affordable but still profitable. Another reason people want private insurance is so that people that have enough money to not need insurance do not have to pay for other peoples insurance, either through taxes or payments. Long story short, governments don't normally have their peoples best interests in mind.*yes I am aware that businesses don't either, but they at least have an incentive existing in the bottom line they must meet*
I just had an AUS friend send this to me to ask if this was supposed to be satire or if this was fact. I studied medical billing and coding for a year in the US and live in the US with chronic illnesses. This is not satire. This is accurate. This is how the US system works.
Nice try, I know this is a joke because it does not, in fact, work
@@crunglemcbungley I haven’t laughed this hard since I finished this video.
Oh my gosh. How do you guys survive
In Aus we have Medicare which means most general consults are government subsidied and you have the option to buy private insurance for certain stuff if you need it. Correct me if I'm wrong though
@@thefabulouskitten7204 we don't
I had to go to 4 doctors to find out i got a type 3 slap tear at work in my left arm and couldn't use it anymore. Workers comp went with the hospitals diagnosis of "hes dehydrated". I lost the case and now live with a life changing injury at 32. I hate this system down to the legal systems tied to the medical scams. Some people go to medical school for money and dont give a shit about who ends up in their "care"
I'm an office manager and medical biller for an optometry clinic, and this video is so handy to show staff so they can better explain this stuff to patients that ask about it. I also put it on WHILE I am doing medical billing, as sort of a bulwark for my sanity!
This is incredible
amazing work
Health care means superb
Good time buck
Good outincome source
Very good
As someone recently diagnosed with a chronic illness and about to no longer be covered by my parents' insurance, this is perfect timing
Check if your state provides subsidized insurance for people with disabilities. That information should be available on your state's department of health/public health website. I ended up paying like $60 a month for Medicare cause I'm constantly dying.
@@user-kh3jj4rx2v definitely will, thanks so much
My sympathies. Also worth checking, if you’re still living with your family and are likely to for the foreseeable future, if you might be able to stay on theirs as a disabled dependent. (Which has its obvious downsides, but as someone who’s remained on parental health insurance after 26 because I can’t really work, I bring it up.)
US health care system is so nightmarish that educational video like this can be tagged as a horror series from how much it can scare your life.
i work as an insurance coordinator for a dental office, now i know the perfect video to show my patients 😂 though they are the same on aspects that are the same and some that are different for dental
As someone with a JOB in insurance, I want nothing more than to burn this whole industry down.
Same. I love helping people find plans that fit their needs but hate the fact that I have to. If I had a vote to get rid of private insurance I would.
Meh they’re probably covered for that
it is your moral duty to do so in whatever way you can.
@@Owl325 oh geez I never thought of it that way. I guess you’re right 🙄
We still hate you.
I just thought you should know that.
As a 29 year old. Learning this all when I left my parents was literally a nightmare. I asked about high deductible vs premiums with my dad. And he just said. Well you gotta decide. Neat.
@im sacred Fr??????????????
i've had this sitting in my tbw list for ages. just got a new job that offers healthcare and figured i should probably finally watch this to figure out wtf i'm looking at. i am so deeply appreciative i literally never would've known to check the tier list for my meds, of which i have _several_
What kills me (literally) is when the insurance companies refused coverage for anything they could label a "pre-existing condition". An infamous case was a young rape victim being denied coverage for her treatment, because she had been raped a few years previously so her being a rape victim was a pre-existing condition.
You what now?
I swear, the U.S. healthcare system should be investigated by the U.N. or something for crimes against humanity.
@@qzamboni unfortunately that will never happen because the US is one of the primary financial backers of the UN
Obamacare got rid of pre-existing condition restrictions.
I...
How in the fuck? Do rape survivors not deal with enough shit already!? Thats baffling, like inexplicably absurd
Pro tip: if you have to take a super expensive medication that has a high copay, the drug manufacturer will often have a program to cover the copay for you. This is because they'd rather eat the copay amount if it means they can still bill your insurance for the rest.
THIS. My specialty medication would have bankrupted me years ago if my doctor hadn't offhandedly mentioned that the manufacturer had a reimbursement system. It's saved me probably over $100K in the past decade.
You guys have to worry about this!?😭
Damn, I didn't know US Americans were struggling _this_ hard...
@@nemo-zl1vm as someone who is not american and does not take medication it baffles me to think that a life-saving medicine could even cost 10k a year. is it subsidised at all?
@@acookie7548 I don't think you understood. That IS the subsidized price.
@@acookie7548 This particular medication gets billed at $40K per dose, and I get 8 doses per year, but my max out of pocket for health insurance is about $7K. With the reimbursement program, I "only" end of paying a thousand or so a year for it. Sometimes my insurance likes to deny my claim for bullshit reasons, so I get to spend a few months thinking I'm suddenly $40K in debt while I beg them to change their mind. Whatever country you live in, vote like hell to prevent them from privatising health costs - it really is hard to exaggerate how hellish it can be.
As for subsidies, there's lots of "it depends" that can take age or poverty status into account. You can theoretically deduct health costs from your taxes, but it's limited and it's difficult to qualify for it.
It speaks volumes to the tragedy of our country that even someone as wonderful as Brian can only end a discussion of this topic on a cynically hopeful, defeated tone. Thank you for all that you do, Gilbo. You are a very tall tree in this jungle of a platform❤
Always reach out to the facility/provider as well. Ask if they offer charity assistance. They can wipe out up to 90% of your bill sometimes, offer payment plans, they may even offer prompt pay discounts so their back office billing doesn’t have to deal with everything said in this video.