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Insurance companies are constantly reviewing us. Are we too old? Do we live in the wrong place? Is our credit score high enough? Well, now it's time to turn the tables. Do you charge too much? Will you pay my claim quickly? Is your coverage worse than it seems? We can review you too.
LA Care - LA Care refusing to pay ER visit
During december this year, I had to go to the ER for a kidney infection while visiting family in Wisconsin.
I'm in California and have had LA Care since I turned 26 and was kicked off my mother's insurance (Blue Cross/ Blue Shield Missisippi) I'm 28 now.
LA Care is now saying that they were never my primary insurance, and that BCBS is my primary, so the responsibility of the bill falls onto them and me.
I had a surgery 2 years ago that was covered by LA Care.
I have contacted BCBS to ensure that my insurance is not still active with them, and it isn't. I three-wayd a phone call with representatives from both LA Care and BCBS to make sure the issue resolved.
Ive been calling LA Care since early this year to have them remove BCBS as my primary since I no longer have it, but as of yesterday, they still haven't removed it, and are still listed as my secondary insurance.
The hospital in Wisconsin and billing me over 6k. I can't afford that, and was under the impression I'd not be billed since a kidney infection is classified as an emergency under LA Care's policy.
I don't know what to do. I'd appreciate any insight on this situation, LA Care is being incredibly unhelpful, and refuses to even let me submit an appeal.
LA Care also covered a surgery I had 2 years ago. I was never aware they weren't my primary insurance.
PENNIE - PENNIE (Pa) questions
I was laid off effective 3/31. (Thanks, Trump and Musk.)
I filled out the application with PENNIE on 3/31. Got approved and told I have 60 days to select a plan. I called PA/PENNIE then. I didn't have my COBRA info yet so couldn't make an informed decision.
I just logged back on to PENNIE and while it still says "you have 52 days to choose a plan," the effective date is coming up as May 1st, not retro to April 1st (like how COBRA works).
I've called and the rep is not well-informed. The last time I called, another rep said "yes you can choose later and it goes retroactive."
State Farm - State Farm Aspirant Program
So I got hired onto State Farm in the Aspirant Program since I already have experience selling life insurance. It all sounded great when they were hiring me. But…..
I am a week into this and I am getting zero direction and am told to just look into the book and see if there is any way to resell life insurance to any clients already with life insurance.
Does anyone have any experience in this program. Because as of now I am a little confused on what this program actually is. It seems more like I got hired to be a sales guy for the agent instead of actually striving to be an agent.
Highmark - Medical insurance denials
Evacore under the auspices of Highmark ( aka Gravemark) has denied my cardiac cath for the second time.
Next step —- letter +\~ phone call to Evacore ????
State Farm - Home insurance while in probate
My father died and we are in process of cleaning and getting ready for resale in Illinois. I called State Farm and explained they told me the renewal in October may be subject to non renewal. And said to add a vacancy clause will be very expensive. Should I shop Around now or wait? I am executor. What happens to utilities if house isn’t insured? Someone told me they get turned off.
Premier Health Solutions - Got scammed, worried I’ll be charged again.
26, tried to get heath care for the first time in January. I thought I was going through healthcare.gov. Guess I called a wack number. “Premier Health Solutions/Health care member services.” Told me 383$ for first 2 months as lump payments then $10 rest of the year. That was a straight up lie. It’s 383$ every month and I will be broke if I keep getting charged. I went through the chat feature to begin cancelation and got an email saying the process has started and I’ll get confirmation but I haven’t yet. I called again about it and they said I’ll get a call from an agent to confirm cancellation. I can’t afford to make another payment and I’m terrified.
PetsBest - PetsBest Review
I recently had to bring my 8 year old Alaskan Malamute (no pre-existing condition) to the vet 3x this month and wanted to share our experience with PetsBest. Here is our coverage:
**Unlimited Annual Limit, $500 Deductible, 10% Co-Pay, 90% Reimbursement Level, "Elite" Plan**
Members October 2023 = $1,297.20/year or $108.10/month
Renewed October 2024 = $1,567.80/year ($1,175.85 paid so far) or $130.65/month
Total paid to insurance as of June 2025 = $2,473.05
**June 6: 1st Emergency Visit**
I brought him in due to a nasty hotspot on his tail. He had to be sedated for the clip and clean and was prescribed multiple medications (gaba, traz, steroids, antibiotics, and animax). He was also given a Cytopoint shot for $240.
Total: $881.92
Not Covered: $6.00 (Hazardous Waste Disposal)
Deductible: $500
Co-Pay: $87.60
Reimbursed: $288.32
*Claim took 2.5 weeks to process*
**June 22: 2nd Emergency Visit**
Started having diarrhea and throwing up June 20. Became lethargic. By June 22, he was on 3 days without a meal and chronic vomiting and diarrhea. Doctor did a Full Panel (CBC, Chem 17, Lytes) & Ultra Sound to rule out underlying causes and blockage, administered fluids to rehydrate. He also needed to be sedated during the Ultrasound. We were able to take him home with probiotics, anti-nausea, and antibiotics.
Total Cost: $2,513.34
Not Covered: $119.48 (Hazardous Waste Disposal & Probiotics)
Co-Pay: $239.38
Reimbursed: $2,154.48
*Claim took 2 days to process*
**June 23: Picked up Appetite Stimulant from Vet**
Total Cost: $270.62
Co-Pay: $27.06
Reimbursed: $243.56
*Claim took 2 days to process*
**June 25: 3rd Emergency Visit - Overnight Stay at the Vet Hospital**
He was on day 5 without food, we were unable to consistently give him medication because he couldn't keep anything down. At this point, he was very very lethargic, stayed in bed all day, and was still having diarrhea. We were starting to get really worried as he has started to lose a bunch of weight.
Doctor concluded that he should stay overnight as they will need to administer medications and fluids through an IV, feed him through a tube, and do an x-ray.
Recommended diagnostics included fecal testing and cortisol test.
We were able to pick him up June 26: His cortisol came back normal, ruling out Addison's disease. Fecal Testing came back Negative.
Total Cost: $4,776.24
Not Covered: $18.54 (Hazardous Waste Disposal)
Co-Pay: $475.73
Reimbursed: $4,281.97
*Claim took 2 days to process*
**SUMMARY**
Total Costs: $8,442.12
My Out of Pocket Costs: $1,473.79
Insurance Covered: $6,968.33
Citizens - When does Citizens cover water damage under HO3 policy?
Hi. I have an HO3 policy with Citizens in Florida and I’m trying to understand in what situations they would actually cover water damage since the reps, my insurance agent or adjuster are not able to clarify this. I have a water damage under my flooring, but again neither the field adjuster, water mitigation company, nor the leak detection specialist have been able to find the exact source of the leak. Insurance wants to send out an inspector who I assume would work in their favor. I’m trying to prepare in case they deny my claim and I need to bring in independent specialists to help me figure it out. I have vinyl flooring installed on top of hardwood floor, and noticed a soft spot so I removed part of the vinyl and found rotten wood. I've never noticed any water on top of my flooring.
From what I understand, Citizens excludes gradual leaks and seepage, but they have a clause that covers hidden water damage if it was unknown and concealed beneath floors, behind walls, or in ceilings. I’m wondering how that actually works in practice. Since there's no known active leak it must be caused by something situational, hidden or accidental spill. I'm having a hard time determining the fine prints since it gives conflicting information. I've included a few pages from my insurance declaration related to water damage in link below:
https://imgur.com/a/sc50G9K
Would Citizens cover situations like:
- Moisture buildup under flooring due to a failed vapor or moisture barrier?
- An AC leak inside the walls over time from a pipe failure or faulty installation?
- Sporadic leaks from an air handler that was poorly installed?
- A cracked condensate line or even a sewage pipe leaking beneath the slab?
- Water spilled sometime in the past which got under the floor?
Has anyone had Citizens approve a claim for something like this, or did they deny it as a maintenance issue? If they did cover it, what kind of evidence did you need to provide?
I want to be ready in case they push back on the claim. It's been over a month already and I am not able to get the renovations started since adjuster wants me to keep it as is for now. On top of that the adjuster wanted me to keep the damaged flooring (with mold) bagged indoors. And he also advised that we live home since the mold did not seem to be a big issue from what he was able to tell from the photos (despite water mitigation company saying that it was over 10sq ft and asked that we find temporary stay since we have a small child until they send a higienist, which they did not get an approval for from adjuster)...
I would really appreciate your help. Thanks
Blue Cross Blue Shield of North Carolina - Constantly Fighting Denied Claims with BCBSNC — Is It Just Me?
I'm honestly at my breaking point dealing with BCBSNC. I’ve had multiple claims denied that should be routine — and I’m exhausted from trying to get clear answers.
Recently, I had in-network bloodwork done that was ordered by my doctor. BCBS denied the entire claim — not even applied to my deductible — and there was no EOB at first. The exact same tests were processed last year with no issue.
In Dec. I had a bad sinus infection, I went to urgent care, and even though the provider billed it correctly as urgent care (POS 20), BCBS processed it as outpatient hospital and denied the appeal.
Last year, I also got stuck with a $1,300 bill after seeing a cardiologist who ordered a stress test at a local hospital. That claim was denied too, because they classified it as an outpatient hospital visit — even though it was a specialty care appointment.
I’ve submitted appeals, contacted billing departments, and chased down paperwork, and BCBS just keeps giving vague, inconsistent responses. I haven’t contacted HR yet, but I’m seriously considering it, along with a complaint to the Department of Insurance.
I’m using in-network care and following the rules. I just don’t know what else to do at this point. Has anyone else dealt with this kind of mess?
Marketplace Insurance - My Wife Told A Representative to Cancel Her Marketplace Plan And They Didn't
I'm filing taxes for the year 2024 and I found out we had marketplace coverage that we didn't know we had. In 2023 my wife began the process of applying for marketplace coverage, but during the process told them she was no longer interested and that she wanted to cancel her application and for them to delete her information.
We have now found out that they did not do that and instead completed the application and we were enrolled for the first 3 months of 2024 before my employer health insurance cancelled it.
Is there literally anything that I can do? It doesn't seem right that we ended up enrolled for something my wife cancelled midway through the application process.
For context, the reason she wanted to cancel was because the representative felt hostile and she had almost fallen prey to a handful of scams, and he kept rushing her to give him her personal information so he could finish. She felt his tone was more in line with scammers rushing marks to get the payoff and tried to terminate the interaction and the application immediately.
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