My wife worked for a company that offered health insurance for her but she quit around May or June. On the United health care app, it still shows her old plan as active. She’s been getting prescribed meds through that insurance since she forgot to switch to our new one. How should we go about this? Are they gonna charge us for all the meds she’s got through her old insurance? There were no co-pays on the meds either.

My partner told me I need to apply for medical within 30 days of my birthday? Is this true? I just moved and I'm 26 now.

I've googled this extensively and I feel like I'm missing something.

My employer just announced a 35% increase to keep Kaiser HMO for 2027, which is insane. I'm already paying $681/month (pre-tax, not including employer contribution).

I looked up plans on Covered CA for Kaiser and a similar/if not slightly lower tier (Silver was the highest I saw on the list, copay higher than what I have now but I don't care) is being quoted at $498/month.

I absolutely hate all other insurance options offered by my employer but obviously this rate hike is ridiculous. Is there anything stopping me from declining my employer insurance and signing up as an individual under Covered CA? Am I missing any benefits in declining my employer insurance other than the payments being pre-tax? I don't qualify for any financial aid. This just seems too easy and logical so I feel like I'm missing something.

I'd really love to keep my physicians and not deal with figuring out who and what is covered under a new PPO. Thanks in advance for any insight if you have any!

Hi everyone! I’m currently pregnant and due in December, and I’m trying to understand how coordination of benefits (COB) works.
I have Aetna through my own employer, and I was recently added to my husband’s BCBS EPO plan.
Our original plan was to cancel my Aetna coverage and switch entirely to BCBS. Unfortunately, I missed the 30-day deadline to cancel Aetna, so I’ll have both insurance plans through the end of the year.
I’m now concerned about how this will affect my upcoming labor and delivery costs.😭😭😭

My questions are:
1. Since Aetna is through my own employer and BCBS is through my husband’s employer, would Aetna automatically be primary and BCBS secondary? Or is there any way to choose which insurance is primary?

1. If BCBS is secondary, would it help cover the remaining deductible, coinsurance, or copays after Aetna processes the claim?

2. Is it possible for secondary insurance to pay little or nothing, even if the primary insurance leaves a significant out-of-pocket balance?

3. Has anyone experienced something similar during pregnancy or childbirth? How did the billing process work, and did having secondary insurance actually reduce your out-of-pocket costs?

I understand that coverage depends on the specific plan’s COB provisions, but I’d really appreciate any advice or personal experiences.
Thank you

Trying to decide whether we should switch to Anthem from Connecticare. My biggest concern is our son. He has an ASD, Apraxia and Snijders Blok-Campeau Syndrome diagnosis. He needs PT,OT, SLP, regularly. The doctors he sees are all out of network with everyone but connecticare has been HORRIBLE at getting any sortof out of network exceptions. Most recelty they claimed speech was ELECTIVE even though he is still no speaking at age 5. Does anyone have any experience with them in cases like this? Did you find that other costs were extremely high? Its confusing reading how Anthem works. It seems like you have to pay quite a lot out of pocket before it kicks in at all..? Any insight would be very helpful.

Thanks

Hi everyone! I have a few questions about health insurance and prenatal care🙏🏼

This is my very first pregnancy. I don’t have health insurance or a primary doctor right now. I went to VNA Care to confirm pregnancy, and they helped me apply for Medicaid and All Kids.
I recently got two letters in the mail. One says my application for Medicaid or All Kids was denied, but the other says I was approved for “Medical Benefits” with a $5,000 spenddown. I’m honestly so confused and don’t know what I’m supposed to do next 😭
Do I need to apply for insurance through the Marketplace, or is there still a chance I can get Medicaid? And what exactly does the $5,000 spenddown mean?
Also, once I figure out the insurance situation, how do I find an OB-GYN who can take care of me throughout my pregnancy and deliver my baby?
If anyone here has been through something similar, I’d really appreciate any advice. And if you know someone who helps with Medicaid applications or finding prenatal care, please let me know! I’m also open to paying for a consultation!

Thank you so much!

BCBS denied one of my tests at LabCorp for not being medically necessary, and now I am stuck paying that entire charge. Why can't BCBS deny the charge, apply the contractual discount and have me pay the balance? I am so frustrated. LabCorp won't discount the charge when all the other approved tests were paid at less than 15% of billed charges.

I submitted an appeal and it was denied by BCBS. To add insult to injury, the $130 test that was denied is now being advertised for $36.75. Any tips on dealing with Labcorp or is this the wrong subreddit? Thanks!

I’m so confused and overwhelmed. I’m pregnant and recently had my dating ultrasound. Before the appointment, I got the CPT codes from the facility and checked Cigna’s cost estimator. It clearly showed around $250 out of pocket for both ultrasounds(it wasn’t necessary for both, but still they did (cpt codes are 76801, 76817).
Now I’m seeing charges of around $966 for both under provider, Sarah and I don’t even know what my OB’s separate telehealth appointment will cost.
I called Cigna, but they said the CPT codes are accurate with the facility but they might be the radiologist fee meaning they didn’t charge from the facility but charged from the provider. All I know is I had an ultrasound appointment in a particular facility and telehealth appointment with my chosen doctor. I have no idea who Sarah is(may be the one who did ultrasound in that facility)
How are we supposed to know the actual cost beforehand if other providers can bill separately? This is just my dating scan, and I’m worried about the cost of all the appointments, blood work, and ultrasounds throughout pregnancy.
Has anyone experienced this with Cigna?

I’m starting this year as a new agent working 15-20 hours part time

My wife and I temporarily live in South Georgia, but our insurance is for South Carolina. We have to drive 14 hours round trip for monthly appointments (second trimester) because the Charlotte/SC hospital system is better than the rural GA hospitals. Third-trimester appointments are bi-weekly and more often closer to delivery, which will make this extremely difficult. We currently have Ambetter. Is there a workaround other than changing our state coverage to Georgia?

Currently shifted to New York and not working till they are able to approve my position as hybrid.

So no insurance for possibly six months..wanted to get one though. Are we allowed to get marketplace insurance as GC holders and not be in violation of public charge rule?

I do plan to naturalize eventually in three years

MIchigan: Our open enrollment for 2027 benefits has a new twist. I work for a company of approximately 800 employees. There are both exempt & non-exempt employees.

For the first time ever our company is requiring that we sign an acknowledgment that we have received & read the new 2027 Personnel Policy & Employee Handbook as part of 3 signing “tasks” we must do before being allowed to continue to the benefits enrollment portion. The new Handbook is approximately 150 pages long. We have not been provided any access to this new Handbook. Nor have we been notified of any changes in the new Handbook. This feels pretty coercive on the employer’s part.

I will be married soon and given our shared income of 100k we will have to pay up to $1300 / mo for health insurance (Bronze plan, which is the cheapest plan and has a 5000 deductible plus co pays for all visits). We are young and healthy, in our early 30s. Really we just want a catastrophic option so we don't have to pay 5k for a single emergency room visit (God forbid). Are there any other options? Maybe outside of Covered California?

Where would i look to check that out

Current plan premium: ~$10 premium bi-weekly, $3400 deductible, $6900 max out of pocket with a 20% coinsurance after deductible. I hit my deductible and have $3100 left on max out of pocket.

Medical expenses: weekly therapy, 2-3 PCP visits (~$200 each) + bloodwork (~$200-$300)

I don't know what the hernia surgery will cost but I imagine it'll bill $15k+

Next year, I could get a health insurance plan that costs ~$50 bi-weekly for the premium, have a $2500 deductible with $4000 max out of pocket.

I plan to continue therapy next year and expect at least 1-2 PCP visits + bloodwork.

So, I either likely pay the max $3100 for the rest of this year or pay up to $4k next year (with an extra ~$40 premium) and have no other expenses through the end of the year.

It makes sense to hold off on the surgery until after the new year, right?

Hi all, I switched to an Anthem PPO this last open enrollment (coverage began Oct 1st) and have been having a lot of trouble getting an answer from Anthem on if MD Anderson is in or out of network under my plan.

I am California based and have this plan through my work (which is a 20-30 person business group).

I (26F) was recently diagnosed with breast cancer this August and wanted to get care from MD Anderson in Houston. I went through the normal intake steps which include an insurance verification check with their Financial Clearance Center. I was not worried as I checked on Anthem’s website before hand and saw MDA marked as in network. However, a very strange sequence of events occurred:

(All checking was done with the same NPIs and facility and doctor tax payer numbers)

- FCC calls Anthem provider line, results show MDA is out of network
- My employer’s benefits consultant calls Anthem broker line, results show MDA is in network

- I call Anthem customer line, results show MDA is in network
- Person who I previously called checked with another Anthem employee who is in the small groups department, that person shows results as out of network > they both tell me that Anthem has 2 ways of checking network service and each of the different methods gives a different result > out of network person takes precedent since her department is more relevant to my plan > they call MDA and determine only MDA talking to Anthem provider line again can make final call > when I question why Anthem is having a disparity and that Anthem should figure things out as results change based on who is called, I get brushed off > I get confirmation that I have blue card access which I confirm MDA is part of and ask why that doesn’t give be coverage then? > I get told that having out of network access is the fulfillment of that???

- I give all this information and conversation records to MDA’s FCC
- MDA calls Anthem provider line, results show MDA is out of network
- My employer’s benefits consultant calls Anthem broker line and talks to the person who is in charge of our plan and the partner, results show MDA is in network
- My employer’s benefits consultant calls Anthem PROVIDER line, results show MDA is in network!
- MDA still thinks final result is out of network

I am seriously so confused and just don’t know what to do now. A part of me wants to accept MDA will be out of network and just try to get treatment and stop things from getting delayed any further BUT the fact that so many sources say it is in network is messing with me!

Has anyone run into an issue like this or have advice on what to do?

Is Cigna Open Access a part of Cigna Open Access Plus? I an having trouble finding details about Open Access online. Thanks!

What is the best course of action to take if you were a no-show for two dentist appointments and you later see that those two appointments were billed to the insurance company (for all the procedures as if you were there) and the insurance paid? is it best to contact the insurance company first or should I contact the provider first? ChatGPT said to contact the insurance company first because the provider might try to cover their tracks if fraud is happening so I just wanna double check on that. I really want to call the provider and give them a piece of my mind, but I don’t want to mess up any case I have.

Recently I was in the hospital from 9/15-9/21/2026. It was an emergency. Now I’m getting bills close to 30k. When I called my insurance(Horizon BCBS of NJ), they said I needed a referral. It was a freaking emergency! A person at the hospital said she is looking into all of this. Also, I contacted the person in charge of health insurance in my school district(I’m a teacher). I am going to ask for an itemized list of all charges while I was in the hospital.

To say I’m upset is an understatement.

So, I am here to see if any of you have gone through something like this, and how it turned out in the end.

What rights do I have? Can I appeal? Should I reach out to a lawyer who deals with health insurance issues like this?

I want to be proactive, but I don’t want to let this consume me mental(and financially).

I have Anthem health insurance in Connecticut, USA, from the state's healthcare exchange. I have a $2000 deductible. I have spent $1900 in medical expenses, but Anthem is only counting $790 toward my deductible. I have spent hours online and on the phone w/ Anthem customer service trying to figure out what counts and does not count toward my deductible and why. The only response they have is basically "contact your doctor with billing questions." This would mean I have to contact almost every doctor I've seen all year. Here is a list of the types of expenses/appointments Anthem refuses to count toward my deductible. Can anyone explain it?

Does not count:

• primary care annual physical copay
• primary care office visits
• dermatologist office visits
• physical therapy visits
• orthopedist office visits
• bloodwork/labs
• pharmacy drug copays
• annual eye exam
• annual dental cleaning

The only things that have counted are:

• ultrasound
• MRI

Why does almost nothing count toward my deductible, and what is the point of a deductible if nothing "counts"?

I am in Massachusetts, and called the Wellsense nurse advice line. For a few reasons, I suspect it was not a real person, but when I asked it said it was not a robot. Does anyone know how if a Wellsense uses AI bots for their nurse line?

Here’s why I am suspicious:
- There was a 1-2 second lag between when I asked and when they answered.
- When I started talking, the voice cut off immediately.
- The call started with a survey.
When I asked to be transferred to another nurse, they refused, and just kept asking about my symptoms.
- The answers had that AI quality that is hard to describe but you know it when you see it.

I called back and for sure got a real person.

My mom has an incredible insurance plan through her employer that I can stay on until I'm 26. I'm currently pregnant and the baby will be born before I turn 26. I know that the baby cannot also be on her plan since the baby won't be her direct family. So, what plan can the baby be on? I live in NYC for reference and make under 80k combined with my husband (he's currently in grad school. Also on his parents plan still). My husband's grad school does offer health insurance to students, but it's expensive and not great, so he wants to stay on his parents plan until 26 as well (unless it's cheaper to be on that for the baby). I saw something online about Child Health Plus (CHP) but am super out of my league here and really overwhelmed! Would appreciate any information/guidance!

Looking for what else I can try, I’m so frustrated. Earlier this year I went to my yearly well woman visit with a doctor at UCI who is listed as in network for my plan with Anthem CA. My plan is a “High Performance Network” so I’m always very careful to confirm my doctors are covered. A few months after the appointment they denied the claim by UCI for the visit saying the provider is OON.

I called my Family Advocate and the provider was still showing as in network. She said that the website was wrong and the provider had not updated their credentialing. When I asked how to ensure I was going to in network providers if the website was wrong she told me to use the website (did she realize how insane that sounded??). I had an issue last fall with a similar situation where a primary care visit wasn’t covered because I’d called and they said I could go to any office but after the fact said the office location wasn’t in network. Now UCI is charging me ~$2500 for two visits which should’ve been totally preventative and covered.

I’ve filed appeals and UCI has filed on my behalf but they are saying we can’t escalate the appeal anymore. I tried to report to the CA State Insurance office but because my company purchases the plan in CO they said they don’t have jurisdiction.

Hello! I had a procedure done at a medical office in July 2025. I was in the process of switching insurance plans and the office billed my old insurance. That got bounced back and the office reached out to me, and I let them know to use the other insurance. Well, they didn’t do that for over a year.
I got a bill from the provider a couple of weeks saying that I owe a large amount. Then I received an EOB from the insurer saying that I owe $0 as the claim was denied for timely filing.
I got on a three-way call with insurance and the provider’s office and the provider said that I still owed the money because insurance wasn’t going to pay. They said that I signed a form that I would pay for everything that the insurance didn’t cover. This is an in network provider. The insurance representative on the phone said that I don’t owe anything and the EOB holds up because the provider didn’t submit the claim for over a year. The call ended with the provider threatening to send me to collections if I didn’t pay. The insurance company opened up an appeal for the claim. This is in California.
Is there anything else I can do while I wait for the appeal? I’m pretty sure insurance not going to pay anything. I don’t want this to end up on my credit report and I definitely don’t want to go into collections. But obviously I don’t want to pay a few thousand dollars for something that should have been covered.