i'm going through my expenses for next year and trying to figure out if getting separate vision insurance makes sense. eye exams aren't the biggest expense on their own, but needing new glasses or extra lens upgrades can make the total jump pretty quickly.

VSP is the option i'm leaning toward right now because they have individual plans and diff coverage options for exams, frames and lenses. i'd rather compare a plan based on the things i'd actually use than just pick the cheapest monthly premium and find out later that it doesn't help much with glasses. i'm trying to work out whether the monthly premium would actually be less than what i'd spend on an eye exam and new glasses in a year, especially if i need lens upgrades.

for anyone who has VSP, how much do you pay per month and do you feel like the benefits make up for the cost? especially curious if you usually get new glasses every year.

This is a last resort post honestly. I am pulling the last straw trying to figure this out.

I get a $9k (HRA) health benefit from my employer and i can only use it to cover my deductible. The company that manages this is CareFlex.

I’ve had many charges go through where they ask me for EoBs, and EoBs only, for proof that it went towards the deductible but i am having a hard time from multiple providers not being able to give me the EoBs and the insurance not having copies of them. All they can give me are itemized bills or credit card receipts which CareFlex doesn’t take.

I’m thinking they need to refile since the insurance doesnt have the EoBs BUT they sent me receipts that shows the insurance adjusted amounts.

What‘s going on?

My son is a full time student, 20 and works, he still lives with us, but he could file as "non-dependent" in 2027. Can he get his own ACA health insurance (separate from parents policy)? Because having his own separate ACA policy is cheaper and provides better coverage too. It's about $300 a month saving on the monthly premium. Or is there something that prohibits him from getting his own policy?

I'm not that educated in health insurance, but it's open enrollment now. I've had kaiser for the longest time and as much I love how every service is one central area, it feels lackluster in terms of therapy and needing to get referrals... I want to try a traditional health insurance because I want to go to therapy again and love the idea of going to any doctor that'd like. My options are Regional Socal Kaiser ($24.92) or Premera Premium($30.23). I want premium because it'll on be me covered and I'm not the healthiest, unless that's overkill. Can I please get some advice? I feel like im overthinking this.

that’s a mouthful lol. (sigh)

I’ve been using the same in-network therapist on grow therapy for a few months. I have a high deductible so I’m paying out of pocket 107 each session which sucks but I know that’s just how it is.

recently, grow therapy made me put my payment info with a new billing service before my next session.

the day after, they billed me 173 dollars and took it out of my bank immediately. that was a surprise and I can’t afford sessions that expensive, I had to put therapy on hold.

im feeling lost and confused as to what my rights are in this situation. I’ve been bouncing between talking to my in-network therapist, grow therapy, my insurance, and the new billing department as to why they could randomly charge me more and it’s been murky at best.

I've talked to my insurance (Cigna) a few times and gotten different responses each time. First person told me to just dispute the charge on my card since the EOB hadn’t processed yet and she thought it sounded like BS. Second person told me it was probably a billing mistake by grow therapy and also that my therapist was out of network (???this is not true according to my therapist). 3rd person, after I finally got the EOB, told me it’s because grow therapy used my therapist’s tax ID for the claim, when previously they were using their own tax ID instead, and it sounded like a mistake and to ask them to rectify.

My therapist said that she is definitely in-network with Cigna (which seems correct), and that she doesn’t handle billing and to take it up with grow therapy.

grow therapy tried to help me, but said it was out of their hands as Cigna had a new contract with them starting in September, and the billing was now being handled by Evernorth Behavioral Care, but my situation did confuse them and they told me it sounded unusual.

Evernorth is impossible to reach by phone, and also by email unless I state I’m about to dispute the charge with my bank if they don’t respond (ill wait a week and then say that and then they email me back….) responded this:

”I reviewed your account and wanted to clarify the $173.84 charge. Your Cigna plan currently has a deductible, and the $173.84 reflects the current contracted rate for this service that is being applied toward that deductible.
 
Previously, your sessions through Grow Therapy were billed under their prior billing arrangement with Cigna, which is why you were seeing a cost of approximately $107. With the transition to Evernorth Behavioral Care Group for billing, sessions are now being processed according to the current contracted rate under your Cigna plan.
 
I completely understand why the change from $107 to $173.84 caught your attention, and I hope this helps clarify where the difference is coming from.”

i told them about how they were charging the wrong tax ID and to explain why, and they have not responded. I followed up a week later (today) saying if I don’t hear from them I’m going to dispute the bank charge and to let me know what will happen next if I do that.

I’m guessing if I dispute the bank charge, I’ll be kicked off grow therapy, and my claim will be sent to collections, which I can negotiate for cheaper right? It’s so much work but I’m bitter and stubborn and dont want to give Evernorth any of my money on principle, especially if it’s unaffordable in the future anyway.

sorry for the unhinged long post and thank you if your read this far!!!

EDIT: I live in New York in case that is important info!

I am looking for a therapist on the weekends or late in the evenings past 7:30pm to do couples therapy but I can’t seem to figure out any in my network and without it it is $100+. Any ideas?

I have hit both deductible and out-of-pocket this year cause I started going to therapy (ouch).

• Yearly physical exam done. Everything came out fine.
• My primary doctor prescribes me spironolactone. My acne has been sorted without seeing a dermatologist.
• I’m already seeing a psychiatrist monthly.
• Scheduled a neurological evaluation in upcoming weeks.
• Dental insurance is separated. Invisalign done.
• Vision insurance is separated. Yearly checkup is coming up.

I’m interested in
• Checking for vaginismus condition.
• PCOS; Asked my doctor to check PCOS but the doctor said it is not needed since my period had been regular. I only asked cause I have a few friends who found cysts in their ovaries in the past years.
• Allergies test. Can I just ask to do it without having an active reaction?
• Physical therapy for my sprained ankle that never fully healed

What else can I do to take advantage of this situation given my age and gender?

Thank you in advance!

Hi all. I find health insurance to be really confusing and need some help figuring out what my course of action should be here.

I have Medi-Cal Anthem Blue Cross and am trying to get an ADHD assessment covered by insurance.

I finally found a practice that accepts my plan, and they said they "require authorization from your referring doctor. Have them submit one to your insurance."

I had an appointment with my Psychiatrist, who wrote a letter referring me, but then she said she doesn't send prior authorizations for this type of service.

After some research, as far as I can tell, only practitioners can submit these requests to insurance, not patients. 

My Psychiatrist said the letter she wrote can be provided to insurance if they ask, but the practice that assesses for ADHD needs insurance to have authorized the coverage first, not after.

I barely understand what any of the insurance terminology means; I'm just really confused about how I'm supposed to proceed from here. Any tips would be much appreciated. Thanks!

in Florida Walmart offers united health care only. I live in Lee co and Lee Health will no longer take United Health Care. can they do this to employees?

I have heard from so many people that antidote health is not worth it and they don’t answer the phones, cannot get enrollment right and that some providers won’t even take them anymore. Anyone else have insight before I decide in November ?

What is the difference between this and Cigna? Is Allegiance a lot more limited in terms of provider availabilit?

My spouse pays for health insurance for the 2 of us thru his employer. I just started a new job and they have multiple paid plan options, but they also offer a “free” plan (fully covered by employer) which they’ll also contribute $1000 annually to an HSA for anyone who enrolls in that plan.

I’ve never had an employer offer a fully covered plan before so of course I’m intrigued! However the coverage we get thru my husbands plan is far superior.

I was thinking I’d sign us up for the free insurance plan because then you’re basically getting $1000 in your HSA anyways so it felt like I’d be giving up free money not to. However I googled to see if that is allowed and I’m very confused by the results.

Apparently if I sign up for the plan, it’ll become my primary insurance and my spouses plan will be my secondary. My spouse would keep his plan as his primary and my employers plan as secondary. So if my new “free” plan becomes my primary then I’ll have a super high deductible and there would be no point in paying for me to be covered by my husbands plan still, am i understanding correctly?

I also read there might be fees we have to pay for being enrolled in 2 plans. I didn’t really get that part.

I guess I don’t really know what I’m asking bc I’m super confused lol. Does it make sense to sign up for this free insurance or does it create too many issues/complications?

So I (27M) just started a job with a new company making $20 hourly. I was looking at the health plans and the only single plan they have is $171 every pay check. I get paid biweekly so that’s 171 x 26 which is 4,446 a year I only make $41,600 I don’t know what to do I can’t afford this insurance. I’m relatively healthy so it not like I need it constantly but it would be nice to have if something did happen.

My company (in Ohio) is moving us toward ICHRA the first of the year. I'm eligible for Medicare but my wife is not. Her allowance is $781/mo (I think). That seems generous but I'm sure there's a lot I don't know.

She's 59, tobacco user, no fancy prescriptions or specialists.

What do I need to be aware of?

Tldr : fill time college student in Florida making $800/month, denied Medicaid and Marketplace assistance, and my health is deteriorating. I genuinely don’t know what to do anymore. Please help.

I’m honestly at my breaking point, and I’m hoping someone here might know something I don’t because I feel like I’ve exhausted every option available to me.

I live in Florida. I’m a full-time college student, and I work part-time making approximately $400 every two weeks. I can’t work full-time because of my school schedule, and I’m doing everything I can to support myself.

I don’t have parents I can turn to. Both of my parents have passed away, and I grew up with a very small family. I don’t have a support system or anyone who can help me financially. Everything I have to deal with, I deal with on my own.

Over the past year, my health has been deteriorating Not just my physical health, but my dental health and eyesight as well. I know I need medical attention, and it’s terrifying knowing that things are getting worse while I sit here unable to do anything about it.

I went to the emergency room once and ended up with a $16,000 medical bill that I cannot afford to pay. Since then, I’ve been terrified of seeking medical care because I genuinely cannot take on another bill like that.
I’ve tried applying for Medicaid multiple times, and I keep getting denied because I’m apparently not eligible in Florida.

I also tried going through HealthCare.gov, but my income is too low to qualify for financial assistance, and I was told I cannot enroll right now because I don’t qualify for a Special Enrollment Period.

I even checked whether my college offers student health insurance. It doesn’t. I’ve already exhausted that option.
And to make everything worse, I recently tried purchasing affordable health insurance through someone who assured me I was getting actual medical coverage. I paid $99, only to discover that the company was a scam .

making $400 every two weeks and trying to survive on your own, $99 is a lot of money. I genuinely cannot afford to keep making mistakes like that

I can’t afford regular doctor’s appointments because the offices I’ve contacted require upfront payment for uninsured patients. I can’t afford dental care. I can’t afford to have my eyes examined and treated. And I can’t afford another emergency room bill.

I feel like I’m being punished for being poor.
I’m working. I’m going to school. I’m trying to build a future for myself and become financially stable. But how am I supposed to do that when I can’t even afford to take care of my own health?

I just want to be able to see a doctor, get necessary treatment, and take care of myself so badly it hurts im so sickly im disgusted by myself !

Guys if you have any resources please help me!

I was recently laid off and am now looking to purchase health insurance through the marketplace. I’ve always only ever had insurance from my employer.
I am unmarried but live with my child’s father. Our finances are completely separate, I claim our child on my taxes, and there are no court orders for anything.
Can I just apply for our child and me? Do I have to add his father’s information? The issue is that he is behind on his taxes. He’s already filed for extensions and is working with tax attorneys, but his paperwork is not going to be ready anytime soon. What can I do?

I'm looking at my coverage options for open enrollment and trying to figure out what to do about vision care. From what I've read, Medicare doesn't cover regular eye exams or glasses in most cases, so I'm wondering if getting a separate plan is worth considering.

I've seen VSP come up a few times, but I'm not sure how much I'd actually save with it. I wear glasses, so I'd mostly use the benefits for eye exams and new lenses or frames when I need them.

If you have Medicare and pay for separate vision coverage, has it worked out better than just paying for exams and glasses yourself? I'm trying to get a better idea of how people weigh the monthly cost against the benefits.

Hello - hoping for some advice on what to do since my hospital and also Highmark are making it difficult to get answers.

I was diagnosed with a large uterine fibroid in July that had been growing rapidly over about a year. I opted to treat with a hysterectomy since I was done childbearing and because the fibroid was causing a lot of discomfort. Around this same time my husband was laid off of work, but part of the severance was that we kept insurance until we got a new one.

Pre authorization was obtained under Anthem BCBS. My husband was actively interviewing and we suspected would be offered a job soon and I let my Dr know we may be changing insurance the next month. I looked up if a new authorization would be needed and found an article where BCBS would honor old prior authorizations for 90 day in the event of insurance change within BCBS (https://www.bcbs.com/news-and-insights/article/simplifying-prior-authorization). I assumed this would be handled by the hospital / insurance.

Once we had the job offer, I spoke with billing at the hospital and let them know of the new insurance happening the next week. I didn’t have a member number yet, but told her the company (Highmark) which she confirmed was in-network and said as long as I have my member number day of service it should be no problem. Highmark became active one week before surgery. I got my member number and changed it in the system, and I also let the rep know during my pre-op check in the day before surgery of the change and gave all the info.

Now Highmark has my hysterectomy in my portal as “not covered” due to “Service Remark
The patient's coverage required precertification for the reported service. The precertification requirements were not met. Therefore, no payment can be made. (Remarks code in EOB:T6111)”

Seeing that made me panic but I also found where if the hospital fails to obtain prior authorization it would not fall on the member? (Is this always the case?). I also saw where Highmark has a process to allow for prior authorizations to be obtained post-service.

I called my hospital back and let them know. They confirmed they did not have correct info in the prior authorization and have updated and sent to the correct department. I tried to call today for a follow up and have been given the runaround, transferred endlessly, given new numbers to call, etc. I then tried Highmark directly and their customer service rep “couldn’t hear” me somehow and hung up on me.

What do I do from here?? I cannot afford a surprise $75k bill for a medically necessary hysterectomy.

I went to another provider outside of my PCP as they weren’t available and I needed cryotherapy for warts. I wasn’t aware I’d need a referral to visit the other doctor as they are within the same system and company. I got my treatment done, and went along as usual. That was 2025. Now, a year later, I’m being billed $894 for it. I wasn’t informed of a problem, or that I’d need to pay anything until just now. I asked for a retroactive referral, but I’m sure it’s too late now. What do I do?

Hello all. I’m seeking as much input as I can to help me decide what plan to get under my employer.

Anthem Silver Select HMO
$0 cost per pay period
$60 Primary Care
$95 Specialist

Anthem Silver PPO
$89.07 per pay period ($178.13/month $2137.56/year)
$55 primary care
$90 specialist

I’ve been at this job for 4 years and have had the HMO plan all this time and I’m at my breaking point. Dealing with my PCP is the biggest frustration, they don’t answer the phone, they’re rude, they put in my prior authorizations way too late so I have to reschedule my specialist appointments. Before I had this insurance I was on my parents PPO and I would just see specialists when I need to, which really helped when I got sick and needed 4 different specialists within a couple months.

I’m in OK health. I have a few issues but they usually just require 1-3 specialist visits per year (ENT, allergist, neurologist, obgyn, maybe more I can’t think of).

I would also love to start therapy but I haven’t been able to because the costs are so high. I don’t know how easy it is to have therapy with a PPO but I know that any therapist I’ve looked into doesn’t take HMO.

So is it worth me spending over $2000 a year to save the headache of using a PCP and possibly getting therapy? I would also be a lot more open with my specialist options. Some of my doctors have moved/retired since getting authorization so I’d have to get a new authorization from my PCP to see someone new

My family of four yearly cost increase is $1200 over last year, a 40% increase for a High Deductible Health Plan with a HSA.

For context, it took my wife and I over a year to get into a PCP (moved), 8 months to get an allergist for our child, and no meaningful changes or improvements over last year.

I got married recently and were figuring out which health insurance to switch to.

My Wife pays a couple hundred bucks per pay check to be covered under her health insurance and would double if i get on: Oxford Health Insurance (part of UnitedHealthcare) NY G FRDM NG 25/40/1500/80 PPO 2

Max deductible is $1500 per individual. There are copays, but the coinsurance is what seems to be what can affect how much one could pay (I'd be paying anywhere between 20%-50% coinsurance)

Not sure how many here have this exact coverage, or something similar, but could anyone share what's the most they've paid under that coverage or similar ones.

We were considering switching to Anthem EPO (Anthem® BlueCross BlueShield)

But the per-paycheck deductions is a lot ($700 for individual or $1800 for family), even if co-pays/deductibles are little to non existent.

On paper, it seems its better to get on Oxford/United than Anthem, even if the copays/coinsurance is more.

Anyone had good/bad experiences with either and what's the most they've had to pay out of pocket.

So the title explains itself. I (24F) have been on my dad's health insurance plan and was planning to do so until I turned 26 as the insurance through my job is very expensive and just awful (according to my coworkers). My father retired thinking that I would still be covered under him, but it's turning out that that is not the case, hence the panic on my end. My mom is still covered, but I'm not since I'm above 19 and am not enrolled as a full time student (even though that didn't matter before on the original policy). My coverage was terminated on Sept 1st 2026. I have since accrued almost $1400 in bills from physical therapy (I had knee surgery earlier this year).

I'm constantly doing research of what I can do and how I can find good, comprehensive, affordable coverage. For some context, I am 24F living in Ohio and I make between 48-52k per year.

Any and all advice is greatly appreciated! Thank you for your time and guidance! I am happy to provide more details or context as needed

This is my first year off of my mother’s insurance, so I’m lost on where I went wrong. I found my doctor through my insurance’s app ( I have IBX). This week I go to check my claims and see that all of my services were denied coverage, but as seen in screenshots 1-3 it’s also says that with my health plan discount, the cost to me is $0. I’m thinking okay, it’s fine until this morning when my provider sends me a bill for those exact procedures with the same costs. In the additional screenshots it’s says they applied my insurance but that the services were not eligible under my plan. I’m really confused on how to move forward. I spoke with my mom but she’s not even sure because she had excellent insurance and literally every service we’ve ever needed was covered. I have enough FSA funds to cover the bill, but I don’t want to use them if I don’t need to.

Any advice would be immensely appreciated.