"Don't go to the emergency room without calling your health insurer first!"
It was a warning we have received repeatedly since moving the United States more than three years ago.
Fortunately, in that time, our visits to the hospital have been few and far between but the warning has always stayed with us.
In the US, if you go to a hospital that is not covered by your insurance plan or see a doctor that is not "in your network", you could be hit with a bill of thousands of dollars for even a minor procedure.
American health insurance is expensive. An average monthly premium for an individual is around $500, rising to more than $1,100 for a family.
Many people are lucky enough to receive their cover through their jobs with their employers picking up some of the tab, but for others it can be a massive struggle to afford healthcare.
The Affordable Care Act, known as Obamacare, was a signature policy of former US president Barack Obama and provided access to medical insurance for millions of low-income Americans.
a challenge by Republican-controlled states
It banned insurers from denying coverage due to pre-existing conditions, expanded the Medicaid benefits programme and established health insurance marketplaces offering subsidised plans.
Former US president Donald Trump vowed to scrap Obamacare when he was in power but Republicans failed to overturn the law in Congress. It has also faced numerous legal challenges in the courts.
The Affordable Care Act is back in the headlines after the US Supreme Court on Thursday rejected the third major challenge to the law.
The justices voted by 7-2 that Texas and other Republican-led states had no right to bring their lawsuit.
Opponents of Obamacare were hopeful of a win given the conservative majority on the Supreme Court, which includes three justices appointed by Mr Trump.
The former president was no doubt unhappy to see two of his appointees, Justices Amy Coney Barrett and Brett Kavanaugh, voting to reject the legal challenge.
Republicans view the Affordable Care Act as a move towards socialised healthcare and have argued that it has driven up costs while driving down the quality of care.
Mr Obama welcomed the Supreme Court decision. "This ruling reaffirms what we have long known to be true: the Affordable Care Act is here to stay," he said.
President Joe Biden said the ruling was a big win for the American people.
"With millions of people relying on the Affordable Care Act for coverage, it remains, as ever, a BFD," he tweeted.
'BFD' refers to a 'hot microphone' moment from the White House signing ceremony for the legislation in 2010 when the then vice president Biden was overhead telling Barack Obama: "This is a big f***ing deal."
While Obamacare may be a "big deal", the US healthcare system is far from perfect. Premiums remain high and millions of Americans struggle to pay massive hospital bills forcing many into medical bankruptcy.
The Affordable Care Act has survived its latest attack, something which is being welcomed by Democrats and those who have benefited from it.
The law, however, has not brought an end to those panicked warnings about calling your insurer on that emergency dash to the hospital.
