One of the most unfamiliar and confusing things about living in the U.S. is the hospital appointment and insurance system.

It's definitely not like in Korea, where you just walk into a local clinic, register, see a doctor, and get your medicine.

In the U.S., the "appointment system" is fundamental. You can't just knock on the hospital door when you're sick; you need to call ahead or book an appointment online. Of course, in urgent cases, you can go to the ER (Emergency Room), but the wait time there is usually several hours, and the costs can be outrageous. So, it's essential to use urgent care clinics or have a primary care physician (PCP) set up in advance.

The PCP system is also unfamiliar. In the U.S., healthcare operates on a "gatekeeper" structure. Even if you have health insurance, you must first see your PCP for treatment, and if necessary, the PCP will write a referral for you to see a specialist.

This means you can't just go directly to dermatology, orthopedics, or ophthalmology like in Korea. I also realized this late when I tried to go to an orthopedic doctor for knee pain and heard from the insurance company that "without a PCP referral, it won't be covered."

So how do you choose insurance? In states like New York, where there are many insurance options, they are broadly divided into employer-sponsored plans and marketplace plans (commonly referred to as Obamacare).

Insurance provided by your workplace usually has better benefits because the company pays more than half of the premium. However, the options you can choose from are limited. If you're a freelancer or self-employed, you can select a plan directly through the New York state marketplace. At this point, the difference between HMO and PPO becomes a concern.

HMO (Health Maintenance Organization) is relatively inexpensive, but you can only receive care within a designated network, and you must go through a PCP referral to see a specialist.

PPO (Preferred Provider Organization) covers some out-of-network hospitals and allows you to see specialists without a referral, providing more freedom, but the premiums are higher. In my case, my company offers a PPO, but the monthly premium is quite high. Still, since having flexibility with hospitals is important while living with kids, I just accept it.

When choosing insurance, you must pay attention to the premium, deductible, copay, and out-of-pocket maximum.

For example, the premium is a fixed cost you have to pay monthly, so you need to consider it within your budget, and if the deductible is high, the premium may be low, but you'll have to pay a lot out of pocket each time you visit the hospital. The copay is the fixed amount you pay when you see a doctor, like $20 to $40, and the out-of-pocket maximum is the cap on how much you will pay in a year, no matter how often you visit the hospital.

Living in New York, I've also realized that when choosing a hospital, it's more important to be in-network with my insurance than just being close by. No matter how reputable a doctor is, if they're out of network, you could face a huge bill.

In fact, a friend of mine received a bill for thousands of dollars after going to NYU Hospital because it wasn't in his insurance network. So, it has become a habit for me to search for "in-network providers" on my insurance company's website before making a hospital appointment.

Another tip is to make good use of urgent care. When you suddenly have a fever or a minor injury, if you go to the ER, you might wait at least 5 hours and end up with a bill over $2000, but urgent care allows you to go without an appointment and has much lower copays. I have designated one urgent care near my workplace and another near my home for weekends. This gives me a sense of stability in my life.

In summary, the U.S. hospital and insurance system is much more complex than in Korea, and patients must be well-prepared to avoid unnecessary costs. Knowing how to choose a PCP, check insurance networks, understand insurance terms, and utilize urgent care can make life much easier.

This is especially true in places like New York, where there are many healthcare options. At first, it can be frustrating and cumbersome, but after a few experiences, you develop your own know-how. I have now become familiar enough to handle most hospital appointments or insurance inquiries with just a few phone calls.

So for those looking to settle in the U.S., remember this.

Before you get sick, choose your PCP and check what your insurance covers in advance.

This is ultimately the first step to navigating the American hospital system.