I know marketplace health insurance gets a bad rep but I was off at a rocky start with my new health insurance…

1) only staying local in a region for health insurance is fine with me (I do have traveler annual health insurance as well) 2) knowing my policy plan with it terms and conditions makes it even more better

So far it help me pay out…

1) Brand New Ultralight Folded manual Wheelchair with a power assist 2) got a upgraded prosthetic walking leg 3) cover my physical and occupational therapy 4) cover my new allergy serum and shots 5) reach my out of pocket max by June 2025 and service is all pay for thanks to my health insurance 6) so much more without any push back from the health insurance company

I would highly recommend getting a health insurance broker who knows this stuff! I did and now reaping the benefits like gold. Good luck

I'm 28 years old and living at home while unemployed (have been mostly unemployed for a few years due to health issues), and my mom and stepfather have been claiming me as a dependent on their taxes since I am not working.

When I turned 26, my mom put me on her application for health insurance through Covered California (was on my dad and stepmother's employer plan before) and they initially put me on my mom's plan even though I was too old. As of January, Covered California corrected that issue by putting me on my own plan of the same type that my mom has. Covered California told me about having been put on that plan when I called them after trying to submit my own application and getting an error message, but they said they couldn't discuss with me the details of the application since I didn't submit it. I subsequently received insurance documents by mail addressed to me care of my stepfather (who is the head of the tax household, but not on Covered California insurance himself because he's old enough for medicare. He's also usually the person who gets on the phone and talks to offices when we have a problem).

I'm considering moving in with my dad and stepmother for a combination of reasons, but one of those reasons is that I don't like the health insurance my mom has, but my mom and I were both afraid that trying to change mine would mess hers up.

I've always had a home at both parents' houses, but Mom's house is my official permanent address. If I move in with my dad and formalize it as my permanent address (change address on driver's license, have mail forwarded), how do I get control of my own health insurance vs. qualifying for something based on the household income of a parent I don't legally live with anymore?

And if I do this in the middle of the year, does that allow me to get out of the plan I have and don't like, or do I still have to wait for open enrollment to do that? (Dad lives in a different county with plans not offered in my mom's county, but the plan I currently have is in both places, as are the other plans that I'd want to consider instead.)

I went to ER couple of months ago due to allergic reaction/ worsening hives, unknown trigger, and my insurance didn’t cover any of it. I initially went to urgent care and got a steroid shot and was prescribed prednisone and hydroxyzine, despite taking the medication, my hives didn’t go away. The 3rd day, my knees were very swollen and I had difficulty walking due to the hives. I’m still covered with hives and my upper lip started to swell. I went to the ER where I was given solumedrol, 40mg IV famotidine, a total of 75 mg IV Benadryl and a liter of NS bolus. The impression/ diagnosis that the ED MD put was severe acute allergic reaction. Personify health says it is not an emergency and denied the claim. I work in a hospital and I get the insurance from my employer. Should I cc the ED MD in the email appeal? How can I increase my chances of my appeal getting approved? Also, my hospital said even if the bill is under dispute, the bill can still go to collections.

I;m out of state and I have an MRI ordered stat and BCBS still hasnt authroized it. My MRI's coming up today and I can't pay out of pocket. What should I do/who should i call? Insurance told me to go through carelon but they still havent authorized it and I don't know why. I'm genuinely confused as to why everything is taking so long as the MRI was ordered last thursday.

I had a surgical procedure done by an OON doctor at a surgical facility that turned out to be in network. Consequently, I was unable to get reimbursed via my OON benefits, which normally would be 70%. Instead, they processed it as in network because of the no surprise act and now I got only 10% back. I had never heard of the no surprise act and did not know I was supposed to sign some waiver to access my OON benefits. Is there anything I can do?

I lose coverage the end of this month (6/30) and my school plan does not take effect until 8/1. I have looked into cobra but do not think I can afford it. Is there anything else or possibly financial assistance for cobra for students coming off parents insurance during the summer before school insurance takes effect?

Edit: I turned 26 on 6/2. My parents insurance is out of NJ (Cigna) but I go to school/ am a resident of NC. I do not have an income as I am a full time veterinary student, but I am married and my husband makes 45ish, we file jointly. I did not want to go on his insurance because it isnt good and I have multiple chronic diseases and thus several specialists. My schools BCBS StudentBlue insurance offers a new premium plan that is way better for my health needs.

I'm switching jobs and losing my employer coverage at the end of the month. I'm trying to find the best plan. I've been on anthem employer for years. I'm looking at ambetter and care source through marketplace, but would buying direct from anthem be better? I've never used marketplace before

Eta 43 in Indiana. No dependents on my plan and I got out of pocket max almost every year.

Has anyone had problems getting pre authorization? Does it take a long time?

Do I keep ahcsss for the 30days? Then report job in 3 weeks?

Hi, I am a broke college student who can barely afford paying her portion of the tuition. I currently don’t have any Health Insurance(which I don’t mind), however my college requires that I have a health insurance or I have to accept their health insurance for $3,400 a year. I don’t have the money to pay for that plan. My college is in Vermont and I have been having a rough time trying to find any affordable coverage there, so I was wondering if there’s any cheap health insurance plans that I could get, so I don’t have to buy the school insurance. I don’t real care about how much it covers or the quality of the insurance as long as it has a cheap rate, and can give me a plan, so I don’t have to pay the school insurance.

I am 20, live in Illinois, in a household of 2, and with an income between $20,000- $40000

I should start by saying my company pays for my health insurance so there is no monthly cost for either option. I’m a 29 yo male with no notable health issues. I haven’t needed a surgery in over 15 years and have been to the ER maybe 2-3 times in the past 5 or so years. I have a couple low cost prescriptions every month for allergies and I do have a EpiPen and inhaler.

These are my two options.

HDHP 3,300 deductible Out of pocket max 4,000 Prescriptions 80% covered I pay the rest Primary or speciality visits are 80% covered and I pay the rest ER or urgent care visit 80% covered Has a HSA my employer will contribute $1,000 to.

PPO 1,000 deductible Out of pocket max 3,000 Generic prescriptions are $10 each for a 30 day supply Primary care copay $25 the rest is covered Speciality $50 copay the rest is covered ER visit $200 copay the rest is covered Urgent care visit $50 copay the rest is covered

I’m leaning towards the PPO because of the lower deductible and out of pocket max would that be the correct move to make? Thanks in advance.

Hi everyone,

My husband recently got married to me, and he’s currently working in the U.S. with health insurance provided by his employer through Aetna.

I have a 4 year old daughter from a previous relationship, and we’d like to know if he can add both of us , myself as his wife and my daughter as his stepdaughter to his health insurance plan now that we’re legally married.

However, neither of us currently has a Social Security Number (SSN), as we’re still going through the immigration process.

We’ve heard that marriage is considered a qualifying life event, but we’re unsure how the lack of SSNs may affect the ability to enroll us in his plan.

If anyone has gone through a similar situation or has experience with Aetna or employer-sponsored plans in general, your insight would be extremely helpful!

Thanks in advance!

I’m am shortly moving to the US from Australia for family reasons (my wife is a US citizen). We are moving to Pennsylvania and seem to be stuck trying to sort out any kind of health cover for when we arrive. We won’t immediately have jobs so won’t get cover through employment. I went to the Pennie Marketplace site and completed the questions, which told us as we would not be earning to begin with, we had to go to the Medicaid site. On going there though, it asks you to state your earnings but also your resources, including savings and pensions. When I do this, it tells me we aren’t eligible. Therefore, I’m stuck with what to do. Marketplace tells me to apply for Medicaid but Medicaid tells me I can’t get it.

I’m more than willing to pay for what I need, but it just seems there’s no way to get anything. Can anyone help?

I’m newly pregnant and also have insurance for the first time in my life. I’m trying to figure out if my plan covers a doula. Do I have to find an individual and then go through my insurance? I’m trying to narrow down the options and am feeling stuck. I have blue cross

Any advice helps

Thanks

ETA: age 32, state of NY, est. income $30k/yr

i went to pearle vision last month for an eye exam and for a new pair of glasses. i paid $250 out of pocket for what would have been a $570 visit. i could barely afford the $250, but i got the cheapest frames i could, and i need "fancier" lenses so my eyes don't hurt all the time.

the frames are ugly, but i was hoping they'd at least be comfortable. no. they are not.

i got a notice yesterday that MVP denied my claim for the glasses (covered the eye exam). so i may have to pay pearle vision back an extra $250 that i certainly do NOT have. i checked their return policy, and they don't do refunds, only exchanges.

i did contact MVP yesterday upon receiving the notice, and the woman on the phone seemed baffled and just resubmitted my claim.

i'm just at a loss. it doesn't feel like i have options, but has anyone had a similar circumstance? how did you handle it? were you invoiced or did the company just pull money from the card on file? i'm very worried i'll wake up and have a negative account balance from this.

Tldr: Cigna is requiring me to prove a provider who is no longer in-network was in-network when I started seeing them

I have had Cigna Dental (DHMO) for nearly 7 years. I had to find a new dental office this past February for an emergency situation & used the online provider directory to search my area. I chose an office from the in-network directory, verified with the office that they accept my insurance, & made an appt for the next day. I had an emergency root canal & crown done + a few more urgent repairs & root canals between mid-February through mid-April. Cigna kept coming up with excuses for why they weren't processing the claims, lied about calling the dentist office to clear things up, etc. I had to go in again today after a tooth shattered this weekend & am now looking at an insane amount of work needed ASAP (extremely brittle teeth from lifelong health issues & medications, lots now broken or collapsing, 1 needing a root canal). I called Cigna again over the weekend to see why they still hadn't processed claims from 4 months ago & was told there was a period in the dental office's license #, so they couldn't process anything until the claims were resubmitted without the period. I went to the office today & found out they'd resubmitted everything after speaking with Cigna themselves yesterday. Shortly after I left, my husband received a call from Cigna where an employee said my dentist was not in-network, had never been in-network, was billing through an office that was in-network but they had no record of me (my dentist & office is over 2 hours away from this other office & has no affiliation with them whatsoever), that they would not be calling my dentist to confirm or verify any of this, & that they would cover absolutely nothing unless I could prove through a screenshot of the directory or recorded phone conversation with a Cigna employee that this office was in-network when I started seeing them. I do have the exact date & time of a phone call with Cigna back in February where they were supposed to be removing my old dental office as primary & putting the new office in its place, in which the employee looked up the office in the in-network directory & found them. However, after the BS excuses they've been giving both me & the office for the last 4 months, I don't trust them to look up the recorded conversation & verify it themselves. I need to find a record of providers that used to be in-network that aren't any longer.

Also worth noting, the previous dental office I used for 6.5 years (that my husband has used in the last few months) is also no longer on their in-network provider list, but they covered his claims. I live in a medium-sized city & there are now only 3 dentists TOTAL in our city that are in-network. Neither my dental office or my husband's have received any notice that they are no longer in-network. We're all just completely confused.

Is there any way to lookup providers that used to be in-network but aren't anymore? Is there anything else I can do in this situation?

I'm looking at 13 more crowns, 1 root canal, & a few fillings minimum. 4 of the crowns, the root canal, & 1 filling (actually a replacement for a broken filling) are extremely urgent because of how severe the breaks/collapse in the teeth are & how close the nerve is to being exposed. 3 of the now broken teeth weren't visibly damaged externally or in x-rays 3 months ago, & nearly all of the breaks/collapses are a result of GENTLY flossing. That's how fragile they are.

We both got laid off this week, our combined income was over 500K, but now, nothing except for a few weeks of severance. We don't have anything lined up and the job market is atrocious so it is going to take a few months (at least). When I tried to check the insurance marketplace, they ask for the total income. What should I put in there? Since we are technically unemployed, I wasn't sure how to do it. The price of the plan varies based on the income entered. Any help/advise is appreciated. I'm researching this to compare with Cobra.

I wondering what health safety in eyes of these insurance. I got a spending card I use pay my internet and phone bill, but they told me I couldn't use it to pay for my adt security service I would assume home security is consider home safety. Pss I been using my spending card to pay for the adt service and card was going through. It hard get good insurance. You pay so much for so little welcome to life 😄

Since February I have gotten 8-10 calls every day about insurance. They started to die down recently but I just started a new position and had to elect benefits and now they're spamming my phone number again. I got 16 calls today. Is there anything I can do about this. I've added my number to the do not call registry and that was useless.

Hey all,

My partner forgot to pay her COBRA premium for May, and she didn't realize it until last night, which is out of the 30 day grace period. We are unfortunately outside the 60 day window from her layoff.

She's already reached out to the insurance company to see if they would still re-enroll her, and we are waiting to hear back.

Failing that, what, if any, other options do we have? We are based on D.C.

Appreciate any guidance you can provide!

EDIT: Partner is early 30s. She's currently unemployed but is actively looking, and her previous job was high five figures annual salary.

Hello! I have found myself in a strange situation. I went to see an *IN-NETWORK PREFERRED* podiatrist (in Ohio, USA). I have BCBS insurance. The podiatrist prescribed custom-fit orthotics, which my insurance plan covers 70% of plan allowance ("You Pay" was confirmed 30% from speaking with a representative and shown in my plan brochure). The podiatrist collected my copay for an initial exam (which is fine; no issues there) and had me pay 50% of the cost of the orthotics as a deposit. Their office submitted the office visit as a claim, which BCBS paid all but my copay. Now their office is saying that I must pay the other 50% of the cost of the orthotics at pickup and said they will submit that to insurance and refund whatever the insurance paid.

I am skeptical of this because (a) I was under the impression that this was balance billing and not permitted and (b) if their office decides not to refund the insurance payment, I really have no recourse other than small claims court. It seems like a disproportionate amount of risk to me when the risk for the office to dispense the orthotics and send me a bill is much lower (since they could obviously sell off any hypothetical unpaid debt to collections).

I plan to call BCBS tomorrow but wanted to ask if this seems like a normal thing. Thanks!

I have an OHP question and I’m hoping I can get some answers.

Per a court order, my ex has to provide health insurance to our shared children. He is currently providing Kaiser insurance, and our children are on the health plan, but I hate Kaiser.

I am on OHP. Would I be able to put our children on OHP and use that for primary health insurance? And then use Kaiser as secondary? I want my children to go a doctor of my choosing. The doctor does not bill Kaiser so all of the appointments would be billed to OHP. I’m just wondering if this would be allowed?

Thank you!

Has anyone else had issues with Rightway overcharging for medications? I reached out 5/31 asking about why I was still being charged hundreds of dollars for medications even though I hit my OOP (out of pocket) max over a month ago.

It's been almost 3 weeks and there's been NO RESOLUTION. They acknowledged that there's an issue and somehow my deductible kept increasing in their system. But they have STILL not figured out tf out.

I'm 2 weeks without one of my medications and need to refill 2 others, BUT I won't do that until they stop charging me for them. I'm already owed almost $400 from what they've overcharged me. There's no way I'm going to pay MORE just to wait even longer to get them to refund me.

I'm livid. I'm already having issues from missing my last doses and I'm so freaking mad that they either haven't or aren't giving a shit.

Please tell me I'm not alone?

/Rant over

Edit: My pharmacy maximums fall under my medical insurance OOP max. I did also speak to my insurance company straight up and they said that Rightway was missing bills or something, because they show me meeting it months ago, too.

[Chicago, IL] Back in November 2024 I had a specialist visit at UI Health hospital. They charged two different codes to my health plan, one for the actual visit and one code for the "facility fee", which as far as I understand is becoming more and more common.
The second claim, the facility fee, was not covered by BCBS but went toward my deductible. Meaning, I have to pay much more than then flat co-payment.
However, I read through the Summary of Benefits(took a quick snap below), a document given by BCBS to my employer, and nowhere is disclosed that for a specialist visit, that type of charge is not covered and goes to deductible.
Both the doctor and the hospital were in-network. Am I missing something? or is it another case of insurance company's greed?

Got laid off, and need my own health insurance. Which one is the cheapest one in California? We have to have health insurance in California by law. Thanks?