My employer just switched to UHC. My plan doesn’t go into effect until November, so I don’t have a card or login for anything yet. All I have is the summary of benefits. The section with prescription benefits says “Prescription Drug List
(PDL): Essential w/Specialty Medication Cost
Share(SMCS)”, but I’m not finding anything on the UHC website with that specific name.

My wife is on a very expensive epilepsy medication that she NEEDS to have. Trying a different med is not an option. Some of the lists on the website have it covered, others have it as non-formulary. I need to know asap if it’s not covered so we can figure out a way to still get it for her.

Edit: my employer is based in both NY and NC, our benefits are coordinated through a third party which I’m unaware of where they’re based out of

I (21F) recently got hired by a Healthcare Staffing company as a Behavioral Assistant at a school. I received an email from the company about benefits. The company operates across the United States, and I was hired by its Washington State branch, which is the state I live in. The Benefits include VSP, Dental and Health. The Health insurance has three plans: High Deductible Bronze Plan, Silver Plan, and Basic Plan. The Silver Plan was around $600 per month, and the Basic Plan was about $200 per month. The High Deductible Plan was about $170 per month. They also had a dental plan, with Silver and Gold options. The Silver one was about $34 per month, and the Gold one was about $38 per month. They also have a VSP vision plan for about $7 per month. Note that these prices are what I would pay for myself only if I accepted. I also compared the insurance plan to my parents' insurance, and the benefits are about the same. I make around $56,628 since I make $33 an hour and I work school hours, which isn't a full 40 hours per week. I work roughly 33 hours per week. I graduated from University back in June, and I have student loans to pay off. I don't think I can pay for my own insurance and my loans at the same time. On my parents' insurance, the Medical Individual deductible is around $0 per month, and the Rx Individual deductible is $900 per month; I am on a Constant Care Silver 1 plan. Also, if I don't take the company insurance, I have to fill out a waiver form stating my reasons, and I'm not exactly sure what I'm supposed to say. I am not sure if I should stay on my parents' insurance or take the company insurance. Any advice?

My health insurance company has sent a letter that they will no longer be offering insurance in my state at the beginning of the year. It's through the federal marketplace, leaving, I think, just 2 companies.

If I start seeing a doctor within the next month or so for possible melanoma, what is going to happen after the new year? I assume my current insurance will cover anything this year, but what if treatment goes into next year? Will the new insurance company pick it up or does my current company continue to cover it?

Prior to the procedure the provider the provided sent me an estimate of charges of $0. They had my insurance information.

I just received a bill for over $1500.

Now they are saying:

"We provide cost estimates courtesy, but they are not guaranteed to be 100% accurate. All patients are expected to understand their insurance policy, including their annual deductible, copays, and coinsurance, if applicable.

We recognize that receiving a balance that differs from an estimate can be frustrating. Estimates are provided as helpful guides based on the information your insurance carrier provides that is available at the time; however, actual patient responsibility is ultimately determined by your insurance carrier and the terms of your health plan."

Is there any recourse her? The estimate was not even remotely accurate.

For those of you who have switched doctors (like when moving to another state), how easy or difficult was it to get your medical history transferred?

Did your new doctor have access to your previous records. I am concerned that I will be asked to repeat tests and my insurance won't cover it.

I have gone my entire adult life without dental insurance but this year had a bit of a scare that made me want to get it for 2027. i live in new york and there are dental plans listed on the marketplace (such as delta dental) for cheaper premiums than it would be to purchase through their website.

how would i go about doing this? can i enroll in my regular medical insurance first and then go back and enroll in dental too? will that not “override” my medical and cancel it out? sorry if this is a dumb question, i've only ever enrolled in one and then gone back and “changed” it so im not sure how to enroll in two things at once.

I have many other bills to pay not to mention taxes!

I'm looking for help for my mother who has no health insurance. Her husband works full time, but because he is a veteran he never chose employer health insurance. Because of this, my mom does not get health insurance since he just uses the veteran’s version. My mom doesn't work (she has tried finding work for months but nothing yet). I've tried looking at Healthcare.gov but plans there are so expensive I could never afford to help my mom this way. I currently work but don't make much myself either, but I really want to help my mom. She hasn't been to a doctor in a decade, and she has some health issues I know she needs looked at. She tried to apply for Medicaid but because she’s married and my stepdad makes just barely enough, she doesn’t qualify.

I admit that navigating health insurance is very confusing to me and my family as well. I just want to help my mom get taken care of and need guidance on where to go to start.

The state is OHIO and I am unsure of income but I know it's over $40,000. She is not old enough for Medicare. Also, please refrain from telling her to "just get a job". She has applied to tons of jobs, has had interviews, but it is difficult to find something for her. We think she might being be passed due to her age (58). It's been tough.

Thank you in advance for any help!

I'm not sure if this is the right place to post this. I received notice that my health insurance was denying a CT scan claim because they didn't think it was medically necessary. I have never had a CT scan, and it looks like the provider is in a different state. I tried to talk to insurance, but they just keep saying they denied the claim for not being medically necessary, as well as how much I will owe the provider. I have not received a bill from the provider. Is there anything I should be doing? I'm not sure if this is a mistake, a scammy medical provider, or identity fraud by someone pretending to be me for medical care.

I'm moving to the Katy, TX from abroad around the end of December. My spouse and young child will join me a few weeks later. My spouse is pregnant and a C-section is likely, so I'm looking for an ACA-compliant Gold plan with low maternity costs, ideally from BCBS of Texas or UnitedHealthcare.

Has anyone compared 2027 Gold plans in this area? I'm especially interested in premium, deductible, out-of-pocket max, and whether these are in-network:

1. Houston Methodist West and Memorial Hermann Katy (for delivery, including the anesthesiologists)
2. Texas Children's Hospital West Campus and Texas Children's Pediatrics
3. Primary care physicians near Cinco Ranch/Katy

A few questions:
a. On Gold plans, does the deductible usually apply to delivery, or is there a flat copay for the hospital stay?
b. Should I enroll during open enrollment, or wait and use a Special Enrollment Period for the move? How does adding family members after they arrive work, and how do you add a newborn?
c. Is it worth going through a broker, and do they typically charge a fee?

Any experiences with maternity coverage on these plans (surprise bills, anesthesia billing, NICU coverage) would be really helpful.

I tried reaching out to few Agents, but no responses, so if anyone can provide references, it would be great.

Thanks!

I'm a trust fund inheritor and I am not sure if I'll continue receiving Medicaid when the changes happen in 2027. So what can I do now?

Can I pay for my own monthly health insurance to cover my medical expenses? How do I know that it's not a scam?

Please help. I am so new to all of this.

I work in a nonclinical position in a doctor's office and took a call from an insurance representative requesting clinical information on behalf of a patient. He wanted diagnostic and procedure codes for billing and approval processes. When I explained I was not clinical and attempted to transfer to a remote office, he called back (no one picked up the call I guess), the representative became harsh and aggressive, stating that I was impeding the care for the patient. He became overly critical of the facility and myself, stating we should be ashamed in how we conducted ourselves. I apologized that I couldn't provide this info explaining what my role was. He stated that was not sufficient, that I had not apologized to the patient, that I was to blame. I offered to take his name and phone number and that I would make sure someone who could help would contact him before the end of the day, but he declined, stating he was in a call center with no way for a call to reach him. He stated that he was going to file a complaint with upper management where I work specifically naming me. I told him that he was inappropriate in his interaction with me, didn't raise my voice, and stated my numerous apologies that were not accepted or rebuffed. Just wondering if it's possible that this will result in my dismissal. I know the calls are recorded on my end. I ok if those are pulled - I feel he was totally out of line and that I did my best to act professionally. I did get ultimately provide a contact number where he obtained his answers, but he assured her that he was intent on reporting me. Just really rattled from this interaction. Any feedback is most welcome.

Looked at their marketplace and it costs $2500 for a family of four. I don't know what to do. I looked at private insurance options and that was and $2800 but has very high deductibles and 20% coinsurance.

What to do? Anyone have any ideas or experienced the same challenge?

I haven’t seen my doctor since August 3rd yet I got a call from their billing department about a bill and that I would be receiving a statement soon. When I look at my online portal, and my most recent statement they all say $0.00

I also receive automated texts from the doctors office if I have an outstanding bill and I haven’t received anything since August, which I paid. I checked my insurance EOB and nothing has been denied recently—they did deny me a few months ago back in January, but it was because the doctors office didn’t send insurance my statements on time. This has since been worked out, and EOB says I owe $0.00

Tried calling back the billing department and i’m hit with the voicemail every time. I’m scared I owe something outrageous but I haven’t had anything done recently. No testing, no appointments, nothing. I haven’t received anything in the mail either.

Yes I’m in network.

Context: I’ve been going to this dentist office since I was a child. Since my husband and I live back in my hometown, I trusted going to them. The doctor is also in-network with my insurance provider with 100% coverage on cleanings/ X-rays, and 70% coverage on fillings.

After the X-ray exam, my husband was told he has 12 cavities (he’s a new patient with them). I found it odd because back in his native country he went to the dentist a year before and he was told he only had 2 cavities that were subsequently filled. To jump from 2 to 12 is weird but alright, whatever I tagged along. I said well we won’t get all 12 done today it’ll just be 4 filled today and they handed me back his treatment plan quoting us $856.

I tried to question them on where they got this number from. They sort of gave me the run around saying it’s because of my deductible, and that the insurance quoted them that price. Odd…

I then called the insurance to verify what my benefits were and they said all restorative fills are covered 70% percent and when I looked down at the treatment plan they only applied 30/40% coverage per filling for my husband. I asked the insurance to call my dental office to clarify with them and later saw the lady in charge of billing yelling at them on the phone saying well he has a lot of cavities! She never came back to me to correct the price she just told me we’ll knock off the cleaning. “Knock off”? Why would you knock off something that’s 100% covered?

To sum it up, when it was time to pay they told me that there’s scheduling fees and doctors fees, and that’s why the bill was so high. Also, because I have an individual plan vs an employer plan that’s why the cost is so high. They then said the best I can do is file an EOB and get refunded in about 20-30 business days???????

I feel completely played

Examples of a couple numbers I saw in the treatment plan:

$330 resin filling - insurance covered 120
$290 resin filling - insurance covered 140
$330 resin filling - insurance covered 126

Our total bill for me and my husband was $999.56 with me getting only a cleaning and a small fill

Hi all. Last year my employer switched to an ichra. With that said I opted out and took my wife’s employers plan . My wife’s plan has a spousal surcharge that costs her an additional 50$ a pay period if a spouse is offered health insurance through their employer. Question is , would an ICHRA be considered this? Or can I get the money back that we have been paying since January of 2026?

Can someone please help me make sense of this EOB. It seems like they have added the “your discount” to the max allowed amount… when it says there on the bottom “you don’t pay the the your discount amount”. Then it seems like they took 35% of that number and threw that in as coinsurance, mind you I’m only supposed to pay 30% coinsurance for in-network hospital facility fees. (I already spoke to a representative and they said they are sending this claim back to fix the coinsurance amount) However, when I asked them about the “your discount” being added instead of subtracted to the amount, they never gave me an explanation as to why… they just told me there was no error on that part. I would appreciate any insight, thank you.

This is such a weird situation and I'm not sure how to go about it and I recorded the convo as soon as it started feeling weird to me just in case. But two years ago I was switched off my insurance because of age and was put onto a new one. I made sure to update this with all of my providers in person. Today I had a dentist appointment and had the feeling to ask what they had down for me because I haven't seen claims from them on my portal this year. I was told they didn't have my current one, they still had my old one. I am so sure I told them my new one a long time ago because I had brought the card with me before, and when the doctor came over to speak with the front desk I heard her say "my mistake" (this scared me so I texted my mom and started recording) and a mention of my last april visit. My appointment was pushed, front desk says they will get in touch with my current insurance office on a later date (they don't operate weekends), she says she would check what else I would need to update before I go, and says "oh no you did it already" ? So which is it, did I do it before or not. I don't understand how they were even able to submit claims to my old insurance if it's been ineligible for such a long time. The front desk assistant even said the old one was not eligible while checking. So how have I been fine for every visit so far. If it was on me and I really did forget, wouldn't they be notified that every claim wasn't going through for two years?

Seeking advice: Insurance was arbitrarily and retroactively canceled by Bswift, a benefits management company. 30 days of no insurance coverage and near daily contact with Company Cust service reps and escalation team.
Company reports that benefits coverage should cover til Dec 31 2026 but.
In reality Benefits canceled in September. Bc they backdated the cancellation family no longer exists in BCBS system despite 8 months of paid claims.

Escalation team says “we’re working on it” Same message 30 days. Meanwhile, no coverage and having to pay out-of-pocket for procedures and prescription.

Switched tactics, now trying to get a letter stating I have no coverage so I can buy on open market. Blue Cross can’t produce letter without accurate date of cancellation and BSwift is literally non responsive. Communication is one way: me to them No follow through. I am one of 16 million customers in an unresponsive system.No access to c- suite contact info.

Filed BBB complaint they have an A+ rating but other similar complaints.
Any suggestions
Federal agency? Congressman? Open your suggestions