Obamacare Sucks: My ER Visit Left Me Paying 100%! 😡 Why? How can I avoid this from happening again?

hey guys Luis mono here with simply health insurance agency today I'm going to respond to a comment that I got on one of my videos from one of the subscribers now I am going to start off by saying I'm not the person's agent I don't know who they're with or even if they have an agent but I think the uh comment is legit I think it's a a legitimate complaint and here is what it is and I'm going to share with you the answer to this or or how I'm going to respond but the the uh responses this I am sick of paying for insurance just to have to pay 100% out of pocket for everything because if I need emergency care I have to contact the insurance company before the emergency how am I supposed to know how am I supposed to know if I'm needing an needing this if it's in an emergency it's all a scam extorting us to pay for this pond SC scheme all right well let's see how we're going to respond to this question or this legitimate complaint so first thing is I'm going to respond well before I even do that guys make sure you comment like And subscribe to the channel I would definitely appreciate that but here's what I would tell you guys as insurance what you need to do number one you need to know your plan don't just enroll on the plan because it's a zero doll plan okay and you're like okay great and you expect the world when you pay nothing okay uh secondly paying more doesn't mean you're going to pay less when you need health care you have to study the plans okay now if you're an insured and you're like I don't know Insurance well then get an agent get a good one I mean how hard is that go search out a good Agent to explain this to you now if if you're my client this is the way I would handle you all right so first thing is let's get in here and I'm going to run a quote okay I don't know I don't know the demographics of this person but I'm going to make it up so let's say I have a 35y old female okay and let's assume she is making $25,000 a year she's single no dependence and she files just for herself so I run this information and this is what I get okay so I'm just going to stick with one company so we don't mess it all up but based on the way this is set up is this is assuming this is a plan we're going to go with here's what you need to know you need to know what your deductible is you need to know what your out of pocket is okay you need to know your co-ace and you need to know your co- insurance and you're if you're an insured like how am I supposed to know that well again why are you buying insurance without an agent because they should be explained to you or maybe you did go to to an agent and the agent didn't explain this to you well then I would say your agent sucks you need to get a better agent because my insurance I explain this to them and I'm going to show you exactly how I explain it to them so the one bad thing about this quoting system here is I don't have quote I don't have co- insurance and I'm G explain all this to you okay so here's what I'm going to do this is the most important document you can get it is called the summary of benefits okay so here is the now there not all the same okay these summary benefits are all different they are specific to that one plan so this summary of benefits is specific to this if I want to get this one down here I click on it it's going to be different so let's go look at the summary of benefits this thing tells me that I have a $700 deductible I know that okay it tells me that I have an out of-pocket maximum of 3,000 okay then I need to go find my co insurance and then I scroll down I see here 30% 30% 30% I see a lot of 30% so my co- insurance is 30% now couple of things to know I have co-pays too if I go see a doctor the deductible does not apply it's 20 bucks if I see a specialist again a $40 co-pay deductible does not apply you have to read this that you have to pay attention to details okay otherwise they come and bite you in the butt okay let's continue okay here are my co-pays for prescriptions again deductible does not apply all right let's keep going all right now she mentioned emergency room all right if you need immediate medical attention okay here is what you have to deal with the emergency room 30% Co Insurance okay Medical Transportation 30% Co Insurance okay Urgent Care deductible does not apply so if you don't see this deductible does not apply then you have to meet the deductible first so it's a $30 coping all right we're going to focus just on the emergency room now look over here okay emergency care okay on limitations there's none you go wherever they take you if you're traveling and you're gonna die or you have a car wreck you know whatever you end up going to you just go to the ER okay you don't have any limitations it's considered in network pre-authorization may be required for nonemergency Transportation so if you're at home let's just say it's you and your spouse your spouse is having a heart attack you call the ambulance 911 isn't an ambulance they take they take your spouse to their ER there you don't have to worry about a network okay Emergency Care has no limitations so I don't know what plan you have now you're like well that's because that's one particular plan let's go pull up another one let's go look at United okay I go to United and let's make this a little bit bigger and let's go to Emergency Care same thing here look magically what are the limitations on the emergency room or ER Transportation none that's with United this go to a different carrier let's go to Etna okay now we're looking at the Etna plan we go here if you need immediate attention emergency room care out of network emergency room care cost share the same as in network no coverage for non-emergency care if you go to out of network and it's not an emergency I'm sorry if you go to the ER and it's not an emergency and it's not in a network kind of screwed it better be an emergency okay that's bottom line okay and again the the transportation the ambulance look in network out of network it's the same I have no idea what this person is saying about it's not you know I have to call the insurance company you know I have no idea okay so that's it now let's keep on going you know let's go prove the point let's go find another carrier Oscar let's see what Oscar does okay we go to Emergency Care hey this is the Oscar summary benefits I go to page three here no no they're going to be on page four if you need a medical immediate medical attention Okay let's see here Hospital State how do they have oh right up here if you need immediate medical attention e 30% this is the in network column here is the out of network column it's the same 30% 30% emergency room Care by an a network network provider is covered if the services are for an emergency condition it has to be an emergency condition so I don't know what this individual is having to deal with maybe they don't have an ACA plan maybe it's something else but if you have an ACA plan guys I've been doing this for so long you do not have to worry about dealing with whether the hospital where you're going to go get Emergency Care is in network or not now if this is not an emergency you have to go to an in network Hospital okay if it's an emergency you go where you need to go and that is it very very simple now let's get back to the cost let's assume you go to it's an emergency and you go to this emergency room at this hospital what are you going to have to pay all right so let's go go back and let's go pull the one that we were referring to let's go to page one sorry sorry for all the scrolling right here this one plan $700 deductible 30% Co Insurance 3,000 out of pocket all right now we're dealing with this particular plan now this is the way that I explain it all right so we know this okay so I have a $700 deductible I have 30% in Co insurance and I have a $3,000 maximum out of pocket now I took my daughter to the ER a couple of years ago she was she was like maybe five or six she had a UTI but she was screaming I didn't know what to do so took her to the ER all right we were in there for about an hour only thing they did is they gave her some juice we were gone all right my bill was four grand so I'm going to use a sample $44,000 bill now the first thing on this $4,000 bill you are on the hook hook for the deductible which is $700 now the good thing about this is it's an annual deductible so once I've met this I don't have to meet it again but it is per person and it up to two people in a family need to meet it all right that leaves me with $3300 left over on the bill so I'm gonna have to pay this okay that's my unhappy face here now we're going to take the remainder of the bill and we're going to split this 70% the insurance company 30% you okay so you're on the hook for 30% of this but there is a limit to this remember that's what this maximum out of pocket means that's the limit so if my limit is 3,000 I've already spent $700 because of the deductible so now I have to spend 2300 30% of 33 3300 time3 okay so now when I do my math here 3,300 times 30% this is going to give me $990 so this $4,000 Bill what am I responsible for I am responsible for $700 and I'm responsible for $ 990 okay so I have to pay $1,600 yeah it sucks but that's the way it is okay that's the way it is now I've paid nine I've paid 1,690 total if I ever go into the emergency room I don't have to pay another deductible I just keep going and I'm going to keep paying 30% 30% 30% once I reach 3,000 I'm done for the rest of that year okay rest of that year I am done all right now let's change plants because this is possibly what happened so let's get back in here and let's say that you had this option but you didn't want to pay a premium I don't want I get a lot of clients I don't want to pay anything okay you don't want to pay anything no problem let's say I go I'm in a silver plan but let's say I go to a bronze plan ah all right let's see we let's stick with the same company here is the Blue Cross their bronze plan not paying anything all right but look look what has changed okay $5,500 deductible 9450 on the out of pocket and let's go here and hit the benefits all right we're on this one particular plan it's a bronze plan right here let's go to let's go to the emergency care uh you and now look things are different now look at this $950 per visit plus 50% all right I know my co insurance is 50% so now things have changed okay I saved $15 but I screwed myself when I need medical coverage okay so sometimes short sidedness comes back and bites you in the butt okay this is where I would be having a conversation with my insured and telling theml you want to save am measly $15 look what's going to happen when you go to the ER you're going to pay 950 and then you're going to pay the deductible and then you're going to pay the 50% Co Insurance you hit the max out of pocket is that worth $15 to you and again if you did this on your own you don't know well that's too bad you shouldn't have done it on your own why didn't you get an agent and if your agent didn't explain this to you well that sucks you have a bad agent you got to get a good Agent all right so let's go do the new math now okay so we have let me look at the numbers again 555 9450 all right so let's get out of here and let's go do some new numbers all right let's get in here and I'm G to erase this erase this all right all this is erased now let's go with new numbers okay so we have we have 5500 on the deductible we have 50% Co insurance we have 9,450 $ and we saw with that one particular plan a $950 copay huh not a good thing all right so let's do this again so let's go with that same $4,000 Bill okay the first thing is I got to pay 950 okay it's like a penalty for going to the ER I don't know why they do that but sometimes they do so you pay the 950 okay let's go back okay get out of here let's go look at this one more time all right so you need emergency you're going to pay 950 for that visit plus the deductible plus the co- Insurance okay not a good thing now look even if you're go to a of network you're going to do the very same thing all right so let's go do this math now okay get out of here let's go back to my little whiteboard okay so I'm going to be on the hook for 950 all right so I'm going to have to pay that yes I'm super unhappy but that's what I get for choosing the cheap plan that's going to leave $3,050 now I have a deductible to meet of 5500 okay this is under that deductible which means I have to pay you know which means overall I still under deductible I'm going to pay I for this one particular visit I'm going to pay 100% so not a good thing not a good thing all right so yeah that $4,000 Bill I'm on the hook for it all right now the $950 just does go towards this 99 so remember you have a $5,500 deductible you have a max out of pocket of 9,450 when you pay this 950 it goes it reduces this amount and then on top of that that's going to leave you with 350 that's going to go into this amount so overall what's going to happen is you're going to reduce this 9450 by $4,000 which is going to make make this is 5,450 what is what does all these what do all these numbers mean to you you're paying 100% again tell me why was it worth it to save $15 okay you know if the immediate okay great but then when you need the service you're like man my plan sucks it doesn't suck it's that's the plan you chose okay you should have chosen the other plan let's put the side by side what you should have chosen doing a side by side comparison is you should have chosen this 1500 you I mean this $15 plan it would have saved you big time so again a lot of the complaints that we get about Obamacare these ACA plants you know sucking all they're terrible they don't cover anything it's not the plants it's usually you or your agent made a bad decision in your coverage okay again a lot of people want to just they don't want to pay anything they want to save money so somehow in this world saving $15 now kind of screwed the insured when they need it health insurance you know kind of you get what you pay for kind of so you know I guess I'm being a little hard there but that's a reality I deal with this day in day out with people okay so it's not the plan it's your choice so what do you need to do as an insured is become educated spend some time if you're doing this on your own you need to spend some time and study the summary of benefits so you understand what you're getting okay if you're dealing with an agent and they're not explaining this to you well consider getting another agent all right or you should ask these very same questions if I go to the emergency room what am I going to be on the hook for what am I going to have to pay if I go to the hospital what am I gonna have to pay if I go see a doctor what am I going to pay if I go see a specialist what about the network are my doctors in the network or are my doctors out of the network these are all legitimate questions that you need to ask your agent or if you're doing this on your own that you need to get the answers for so I'm sorry that this happened to you it's not a good thing you can't do anything about it but possibly consider switching to a different plan if it's possible if you need help from us we would be glad to help you you can click down below there's a link down there for you to click and I would love to help you out thank you again don't forget to comment like And subscribe