Hi all, (Reposting because I didn't know how to format) TL;DR: Insurance denying approximately 40K worth of costs (approved line items, just more expensive in the region than their estimate), went to appraisal with adjusters, umpire selected, month later learn that insurance company is now represented by lawyers. We experienced a water damage claim impacting a 3-story townhouse, all continuous wood flooring, walls, and kitchen cabinets, counter, backsplash, with Traveler's in Dec 2023. We are located in King County, Washington; the house is built into a slope not directly accessible to the street and is stand-alone (no shared walls) on a plot with 3 other homes. My initial quotes from contractors up to 100K. I went with a contractor who quoted around 80K, good guy. Escalated through several Traveler's adjusters in Winter 2024 until an adjuster came in person in late Winter and agreed with our contractor and the work moved forward. The insurance company adjuster recognized that the costs were going to be pretty high and was working well with our contractor, it seemed. I handled cabinets, backsplash, and counters directly with a subcontractor and my contractor handled drywall, paint, flooring, pack-out and move in, and more. I got approval from insurance adjuster along the way and ended up getting approval for all of the kitchen work, fully covered, around 33K. Due to delays from Travelers and subcontractors, with materials being hard to come by, our kitchen floor was unfinished with nails sticking out until May 2024. We wanted to keep things moving and settled on cheaper flooring than an exact match that was available sooner than the Fall, so we moved out in May (I had gotten approval for housing costs in early May from insurance for several weeks). Then, for whatever reason, their adjuster stopped responding to my contractor for a few weeks in, approximately, late-May and June. The flooring and painting work was finally done and the cabinetry, counters, etc. mostly got done in mid-late July. The work was mostly completed by August except for a few small things. The final costs of the new installation of cabinets, counters, backsplash in the kitchen, which I had handled and which had been covered, was approximately 33K which has all been paid out and completed. Mitigation was done for 6.6K with a separate company. The remainder of the tear down, pack out, dry wall, painting, flooring, cleaning, plumbing, electrical, etc., onwards from my contractor ended up being 105K. With the previous adjuster, the claim was sitting around 70k estimate from the insurance side with an expectation that it would go up conveyed verbally with their adjuster several times. In this period, since the insurance adjuster had stopped responding, my contractor had reached out directly to Traveler's. At some point a new adjuster was assigned and then, in June/July, the case was passed through, I believe, 3 more adjusters. The final adjuster basically went through and wrapped up the claim, including recoverable depreciation, but didn't really acknowledge the actual costs of the materials, labor, compared to their estimate and essentially closed the claim at approximately 95K total, which included mitigation, kitchen, and the contractor's work. That left a gap of approximately 40K still due to my contractor. After a month or so of back and forth, we agreed with the final insurance adjuster, to go to appraisal in November. We selected an adjuster. It seems that nothing was happening for several weeks and then eventually Travelers selected their adjuster and he actually came to inspect the house in December. Then per our adjuster, unable to be reached/unresponsive for several weeks. Once they did get into contact and went back and forth in late February, they finally agreed on an umpire. Then, out of nowhere, in mid-March, the third party adjuster representing Travelers informed our adjuster that Traveler's had assigned or hired lawyers to handle this claim and they were no longer continuing the appraisal as previously agreed upon. Here is the policy language regarding appraisal: ...7. Appraisal. If you and we fail to agree on the amount of loss, either party may demand an appraisal of the loss. In this event, each party will choose a competent and impartial appraiser within 20 days after receiving a written request from the other. The two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of a court of record in the state where the “residence premises” is located. The appraisers will separately set the amount of loss. If the appraisers submit a report of an agreement to us, the amount agreed upon will be the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will set the amount of loss. Each party will: a. Pay its own appraiser; and b. Bear the other expenses of the appraisal and umpire equally. My question is - why did Travelers go with attorneys after there was an umpire selected? - Could it be something as simple as the timeline being so protracted? We have emails showing the umpire was agreed upon a month ago. - I am concerned that, as I see in this community, our adjuster was filling the costs to try to get a better negotiating position... Not sure if that would play into this...? - The work was expensive and challenging to complete but there are no line items that were not previously approved - they just cost more than what the insurance company estimated. I have not heard anything directly from Travelers. My contractor has been wrecked in this process, it's been tough for me as well. The idea that we need to face an attorney is rough. Appreciate anyone's insights or guidance! TL;DR: Insurance denying approximately 40K worth of costs (approved line items, just more expensive in the region than their estimate), went to appraisal with adjusters, umpire selected, month later learn that insurance company is now represented by lawyers.

Sorry everyone this is a long one and I don’t have a good way to TLDR it. Just for a quick note, I have USAA for auto insurance and my vehicle is a 2017 Corvette Z06 in 3LZ trim, Z07 package, and 52k miles. I own the car outright and it is titled/registered in NH. So a little while ago I was driving in heavy rain, hydroplaned, lost control, hit another car in a few places not too hard, and slid into the median. The cosmetic damage is pretty bad. A few body panels and aerodynamic parts of the car were damaged and will need to be completely replaced, as you can’t repair fiberglass/carbon fiber. I estimated myself that the cosmetic damage alone would cost $25-$30k (take that for what it is, I’m not expert lol). I had a chance to look under the car and nothing looked terrible - only thing of concern was a rear wheel that was canted slightly outwards. I towed it to a shop and they’ve found no frame damage; they’re saying it’s completely repairable. USAA got an adjuster to do an estimate on the repairs and it came out to almost $32k without having taken apart the vehicle. Their estimate also included a substantial amount of work being done on the rear suspension, if needed, which is probably the only mechanical part of the car which would’ve been damaged. Their Actual Cash Value (ACV) for the car came out to be almost $61k at the time, and since the repairs were estimated to be over 50% of the ACV, they deemed it a total loss immediately. But I knew that ACV was wrong, because no low ballers, I know what I got. In all seriousness, their report included the methodology for calculating the ACV - they compare my car to two similar cars for sale in the area. However they made a mistake and compared my car to two base model Corvettes which, brand new, went for anywhere from $30k-$45k cheaper at MSRP. They also left out very valuable features my car had as OEM equipment like the carbon ceramic brakes which go for about $16k brand new. Obviously I know I’m not getting full value for these things, I’m just saying they certainly add value. Anyway, they admitted their mistake in comparing my car to two non-comparable vehicles and redid the calculation. The new ACV is almost $87k now. Now, I know a lot of you if not all of you will say take the money and run, but this is a dream car for me - it’s spec’d perfectly and I’ve done a lot of work on this car all by myself, so it has a lot of meaning for me. I could take the owner retainment settlement option and receive $48k, repair the car myself, and pocket extra money (because I know these repairs wouldn’t cost more than $48k), but they would issue a salvage title, and I couldn’t do that because I’d still want full coverage on the car. But even with this new (and correct) ACV, USAA refuses to not call this car a total loss. Repairs would have to exceed $43k to be over 50% ACV and, by their own definition, be a total loss. Additionally, in the state of NH, generally when a vehicle is involved in a collision the damages need to exceed 75% of the ACV to be deemed a total loss. This is what USAA has recently sent me as I’m still fighting them to get the repairs done, “I can understand your point, however there was no mistake in deeming the vehicle a total loss at start, you were interested in more value in the settlement. The fact that the added value was reviewed doesn't remove it from a total loss stance. We still report it to the State as a total loss, the features and conditions that were modified as a courtesy increased the value here.” So my question is, can they do this? Still deem it a total loss even though from the start their calculation of the ACV was incorrect? I disagreed the car was a total loss from the very beginning, I wasn’t looking to get more money from the settlement, I just wanted to ACV to be correct. I’m not even looking to pocket any money from this, I just want my car fixed.

I had an MRI arthrogram ( contrast for hip labrum and joint) and it was coded 27093, 77002, and 73722. And then the pharmacy drugs. My insurance is trying to bill this a surgery as they say code 27093 is under the surgical code section in the CPT guidelines. Normally I would have 100 percent coverage for any outpatient clinic ( non hospital) MRIs. My insurance says even though this was not done at a surgical centre or with a surgeon ( only a radiologist), they can charge me as if it was a surgery and therefore also charge the radiologist as surgeon fees. Does this make any sense at all? That way they say I have to pay 20 percent of the whole package of MRI ( 73722), Radiology diagnostic ( 77002) , and the local anesthetic used by the radiologist prior to the iodine injection ( 27093). So even though my work insurance normally would cover radiology diagnostic and all imaging at 100 percent, they say because of 27093, this is now a full blown surgery and only covered at 80/20 rather than 100 percent. Is this true? I will post in CPt code section.

Going from $113-$127, smh should I look into switching or would it be the same anyways?

Hello everyone, a couple of days ago I was involved in an accident where I was merging and hit a car that was in my Blindspot. I feel awful but I maintain that I did everything I could to avoid it. I checked over my shoulder. I use my blinker, my car has lane assist. The car that hit me just came out of nowhere. I took my car to an auto body repair shop that is owned by a family friend and they quoted my total repair at $7600. progressive told me that if the cost to repair my vehicle is 50% of my cars total value that they will just total it.. I do not want my car totaled as it’s almost paid off and I don’t think it’s even that damaged I could just replace the passenger door on my own and be done with it, I owe about $1700 on my car and progressive also told me that if they total it that the bank might take my car!! I would rather just go pay off my car and fix the door myself. Can anybody give me an input or help? To make matters worse my husband is active duty and we are leaving in 8 weeks across the country. I feel sick

Edit: Total amount that was for the insurance that month was like $400 something. I think around $430. Not sure if that has something to do with it Hey so I had gotten my car back a couple of months ago. To put it short, for some dumbass reason my ass didn't think I would need insurance to take the car off the lot and didn't factor that into it, as the last time I gotten a car I went to a shady shitty dealership which let me drive off with just liability. So I had set myself up with Bristol West. Thing is I did not have the money for the insurance but it went through because I did an option that would collect over a few days. It showed as active for me to collect my car. Anyways immediately like a day or two later, I decide to go with Progressive which was much cheaper and canceled my plan with Bristol by calling them. (I used Bristol to pick up my car but then changed it to Progressive and they took that) After it got canceled I got some mail saying that I owe $110. Now question. I do know that say if you cancel mid-cycle or early they give like a "refund" or don't make you pay the whole amount. My question is, does $110 seem right for literally using them for about a day or so. Keep in mind they couldn't even charge me but it showed my acc as active. Active enough to try and get my car. Does anyone have any experience with this? How do they decide how much to charge you when you cancel, Does it matter when you cancel or they just give you a rate which you have to pay. I just realized that they sent it to debt collections and want it.

I decided to go with progressive when I purchased my new car in march. I paid $850 for my 6 month plan. I just got my renewal and they want 1400!! I used the snapshot and got 4/5 start, haven't had any tickets or accidents since I started with them. I hit a deer in November of 24 but that was report on my first plan so what's making my rate so high? I got on their website and did a quote for myself (including the deer accident) and it said $700 for 6 months.

My grandma has a dog and we helped her get insurance for him a while back, but her dementia has progressed quickly and pretty dramatically so my mom has taken over his care. (My grandma lives with my parents so she’s always had a big part in his care but now my mom has him full time). We have Lemonade. My mom told them what was going on and they said they could add my mom as a co-owner, but then she couldn’t make adjustments or any changes to his policy. Otherwise, she would have to cancel his account completely and start a new one under her name. She wanted to cancel it and start it under her name since sadly my grandma will not get better and she wants to add dentals to his plan, but he did have anal gland issues this year and lemonade said that if he has anal gland issues in the future they would no longer be covered under my moms plan because they would be considered a pre-existing condition now. Just looking for advice on what to do. It doesn’t seem fair, but I know insurance isn’t fair lol. Should we look at other insurance options? Or just add my mom as a co-owner? The anal gland issue was expensive so we don’t want to lose coverage on that if it comes back but also it sucks that my grandma has something we couldn’t predict nor control and now we’re in this predicament. Any advice would be helpful!!

nybody here have mediCal? (Govt free medical insruance in the usa for ppl under age 65 and unemployed or flat out broke). My uncle generously cash paid for my mcas doctor. I have a script for cromolyn sulfate, can I use the script at the pharmacy and will medi-cal pay for the meds? Usually people with California state Medi-cal for those under 65 are unemployed or too sick to work but not yet documented and broke like me, so qualify for medi-cal, but those doctors are the worst and most incompetent. My uncle paid a mcas doctor to see me, abd I got a script for cromolyn sulfate. Usually medi-cal will pay for my meds even if i saw a cash pay doctor. Or is it a situation whereby I need to prove that I used lower level meds and they didbt work before I get approved from cromolyn sulfate? Remember I tried to get triamcinolone cream under private insruance (blue cross blue shield), but they said i had to trial lower level creams and then fail those 2x first. Making me waste life energy and jump thru hoops so insurance company can save 20$.

Hi all, I’m in a common and frustrating position revolving around paying for health insurance. Here is my situation. I work part-time and go to school part-time, so I don’t qualify for full-time benefits for work or any equivalent part-time healthcare offers in Michigan So that’s the first part. I gross about $600 a month working and my healthcare premium is $650 a month alone for BCBSM HMO Gold plan. It just is not feasible to pay that much for healthcare anymore- especially, out of pocket in full. What I do have is Medicaid and CarePayment accounts that help me cover the costs and pay down medical debt in a reasonable time frame. I need some coverage because I have a mental health condition and commonly use: medications, psychiatry, therapy, and labs. I am wondering if I can get by just with MI Medicaid. Is that risky since Medicaid has very low reimbursement rates? Or is it reasonable to go with Medicaid and just try to be frugal medically? What I want to avoid is going for routine procedures and leaving with a $1200 bill, AND paying $650 a month only to use it half hazardously. Thanks.