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Blue Cross Blue Shield - Marketplace and my insurance screwed up, and now they’re saying it’s my fault. What can I do?
This might be a doozy, but here I go. Thank you advance.
I decided to get my own insurance (so my insurance wouldn’t be tied to my job in the event of job loss). I searched in marketplace. I entered my criteria to find a plan that covers my PCP, my daughter’s pediatrician, and my medications. Marketplace found me a plan that covers it all and I enrolled in December to start in January.
Today I had an appointment with my PCP. As I checked in, I handed them my insurance card, and they let me know he was not in network. Which is WEIRD considering I made sure I picked a plan that he was in. I left and called my insurance. They told me he was in network. They confirmed his address and phone number - it was incorrect. It was his old hospital from over two years ago. I gave them the new information. She left me on hold for a while and came back and apologized, saying he was NOT in network with my current plan. She said since I got my insurance through marketplace, I need to contact them. So she transferred me to marketplace.
I’m now on the phone with marketplace. I speak to the representative (who was clearly in a bad mood) and he had no idea what was going on so I had to explain the situation again. He put me on hold and when he comes back, he says that he’s not sure why I’m talking to them when I should be on the phone with BCBS. I told him that I got insurance through marketplace, and I only picked my plan because it was in network with my doctor, which was clearly incorrect! He said that I was not entitled to 100% accurate information on marketplace and it was my duty to double check to make sure my doctor was in network. Which, according to BCBS, he WAS! At his OLD PRACTICE. From two years ago. And he is not now. I asked about changing my plan so I can actually see my physician and he said open enrollment was over and I would have to qualify for special enrollment which we could not do today. He told me to call BCBS again.
I call BCBS again and the new CSR I spoke to was even worse. She basically told me to call marketplace. I told her what they told me and she said that was incorrect information and it was up to them.
I am on the verge of tears right now. I’m playing this back and forth and I don’t know what to do. Do I make a complaint with marketplace? How do I go about it? None of this is my fault but they’re either blaming each other or blaming me. I just want to see my doctor, man.
TLDR: got insurance, was told he was in network, turns out he isn’t in network because of incorrect address on file, and now I’m trapped in a limbo with BCBS and Marketplace and no one is being helpful.
ETA - unsure if this is relevant in this situation, but I am 32, in Oklahoma, and gross income is over 100k. Maybe 140.
MetLife - Avoid MetLife pet insurance
Got metlife pet insurance to cover dental work needed for my dog. I got the Preventive Care plan add-on so her teeth cleaning would be covered. Right in the policy it lists Spay/Neuter or Teeth Cleaning: $150, per pet. Submitted my claim on 12/17 and finally got processed today 1/17. They rejected the claim on grounds of it being a pre-existing condition. My dog's teeth had plaque on them so they denied the claim. How in the hell do you get teeth cleaning covered then?
Tricare - All my referrals are gone on Tricare except for a doctor I've never heard of. Is this happening to anyone else, what can I do?
Healthy Paws - How is everyone organizing against Healthy Paws?
State Farm - State Farm: Ensuring that vehicle modifications would be covered in the event of a total loss?
Greetings, I have State Farm insurance on my truck, which I've been gradually making improvements to for off-road use over the past 2 years I've had it. As of right now, I have about 18k invested into it excluding labor.
I've asked my SF agent aboput gettin an endorsement and they verbally said that my current policy should cover it as long as it's bolted to the vehicle and that I've kept photos and receipts, but I still worry I could end up in a situation where the vehicle is stolen or wrecked in an accident, deemed total and I'm offered far less then it would cost to purchase a similarily equipped truck used on FB marketplace. I'm a bit skeptical of whether or not this is accurate or whether i'd be severely low balled.
I live in a fairly urban area where property theft and unisured reckless drivers have been sharply increasing.
I skimmed over my policy but nothing stood out to me in reguards to modifications, but perhaps I missed something? I'm just trying to make sure that I'm not screwed . One scenario I'm worried about is getting a low ball offer for the vehicle and then hoping there is an avenue to buy it back so that I can transfer the viable parts to another vehicle of the same model, selling whatever is leftover for part and taking a huge loss.
Metlife Pet Insurance - Metlife Pet Insurance - change of address
Just a little PSA for people who weren't aware, when you move you may lose access to your old policy. I've had my policy for 2 years and in that time one of my cats turned 15. because I'm moving, they are charging me a deductible again and also won't cover my cat on the same plan anymore due to age. I'm going from 80% coverage on an unlimited amount to a cap of $2,500. in a HCOL area.
I'm obviously devastated but just wanted to share. might have chosen a different place to live if I'd known how screwed I would be.
Wawanesa Auto Insurance - Wawanesa Auto Insurance
Hi I would like to hear your thoughts on Wawanesa Insurance? Plan to switch from AAA to Wawanesa. AAA double my insurance, no accident or traffic ticket. Please let me know. TIA.
Mortgage Company - Real Estate property tax - land auctioned off
Looking for advice on what my options are. I'm on a high school teacher salary and never had to seek out an attorney for any reason. Location: Oklahoma
Long story short: My home & small piece of land are on 2 parcels that were purchased together. In late 2023 l received notices from the county that my taxes weren't paid. I called my mortgage company since they're the ones that have been paying them each of the previous years we've owned this house with no issues. I got another letter from the county in 2024. I called mortgage company and let them know it happened again. They said we're on it. I left the country for work for 4 months while my wife and kids stayed behind. While I was overseas we got another letter saying my property would go up for auction if taxes aren't paid. My wife called mortgage company again, they say they're going to get it taken care of, not sure what the issue is, but they're on it though.
Right before I come home, my wife gets a letter from the county that our property was auctioned off and we have 1 year to appeal the sale. It was only one of the 2 parcels we own that got sold off - a .5 acre plot that's basically my front yard all the way down to the road.
After back & forth with county and mortgage co. we found out the issue was that the actual mortgage paperwork that we signed does not list both parcel numbers. We owned both parcels according to the county, but the bank said oh, well we only paid for the taxes listed on the mortgage you signed, not our problem. Problem for them is, the descriptive measurements in the paperwork include both parcels, they just forgot to type both parcel numbers in.
Mortgage co. admits fault. We get a letter from them saying that they messed up and are fixing it. Haven't heard anything in a while so called today and was told the last thing written in the notes for my account are from a few months ago that said the company was trying to purchase the property back from the person that bought it at auction. I'm waiting for a response from someone else higher up, but I feel like they're intentionally dragging their feet to get to the 1-year point where nothing can be done.
I don't need the "why didn't you just pay it yourself, you're equally at fault" response. I was in Germany and that's neither here nor there; the ultimate point is that the bank admitted it's their fault and are trying to buy it back but it's been almost 5 months and no progress.
What are my options that I need to be finding a quality attorney for?
Workers' Compensation - Massachusetts – Workers' Comp Delays Blocking Medical Care – What Are My Rights?
Location: Massachusetts
Hello. Up until today I've only ever been a silent lurker in this sub but I'm feeling kind of lost in this situation of mine. I've tried to keep as much information vague as I could while still maintaining relevance. Apologies in advance for how long this turned out to be.
I (28F) am a field technician. I was injured on the job in a car accident (not at fault) while driving between work locations. It was a pretty bad accident, but I was lucky enough to get away with only a couple of injuries. Long story short, after a 13 hour stint in the ER they told me to follow up with my primary and sent me on my way. I knew I’d be out of work for a while, but I had a small nest egg to fall back on in the meantime so I wasn’t all that worried.
The next day I called my primary care doctor and found out he had recently left the practice, and the only other doctor there did not take Worker’s Comp claims. None of the clinics or urgent care centers I contacted would take workers’ comp cases either, without prior approval or referral from WC themselves. I returned to the ER in my town about a week later and was referred to a clinic (Let’s call them OC) that would treat me—but only if my workers’ comp insurer (WC) signed a fee agreement.
Shortly after, a rep from WC called me. I mentioned that I was considering legal counsel for a possible third-party claim against the at-fault driver and she replied that if I retained a lawyer, it would be unethical for her to speak to me any further and that she would only speak to my attorney from here on. A day or so later I did eventually retain a lawyer—but only for the personal injury case, not workers’ comp. From that point on, both my lawyer and I called the WC rep daily for over two weeks, with no responses or voicemails. I had to get my HR rep from work to reach out directly and received a reply from the WC rep almost immediately. She told my HR rep that they could not sign this fee agreement until she had completed her investigation. At this point it’s been like 19 days since the accident with no communication from her whatsoever. I called every day and left a voicemail every day, more so to document the lack of follow up on her end.
After three more weeks of this I reached out to my HR person again and she was able to see that my claim was denied about two weeks after my accident. The denial haad a note that said I was unreachable (false) and she also found a letter that was formally filed with the state saying I was denied because I had deviated from my route (also false, and never discussed with me). My HR person was able to get WC’s supervisors involved, and the WC rep contacted me shortly after to report herself that the denial was due to “failure to report in a timely manner.” At this point, I won’t lie, I was pretty angry hearing that, but I was still trying to keep cool. Calmly, I pointed out that WC rep’s lack of communication was the sole cause of this denial and she pretty much just brushed me off and started asking other questions related to my claim, presumably to actually file it properly this time around. She then verbally accepted the claim “without prejudice” and told me the OC fee agreement would be signed that day.
I went over this whole issue with my attorney and she said I shouldn’t rock the boat if they’re cooperating now. My problem is, it’s been a month and four days since WC rep said that she’d sign that agreement “before the end of the day” and the agreement is still not signed, so are they really cooperating? I have not seen a specialist for my injuries to this day and without going into detail, I’m basically bedridden at the moment.
Roughly one week after that call a WC supervisor reached out and told me I would need to sign and notarize a Section 19 agreement. This was the first time this agreement was mentioned, and no one indicated it was a condition for approving treatment. Over the following weeks, I continued to check in with both the supervisor and the original WC rep as they negotiated the fee (or so they claimed) with the specialist’s office. At one point the WC supervisor says that they have reached an agreement and that they were preparing to sign a finalized version. After about a week or so I reach out to the WC supervisor, who hands me off to the WC rep, who then says that she was waiting for the signed Section 19 from me first—implying that the fee agreement was being held up until then, although no one had explicitly stated that before. When I asked for that clarification, the WC rep clammed up again and stopped responding. I’ve asked twice with no answer, and when I asked a different question on an email chain she and her supervisor are both on, she responded right away to THAT question, refusing to answer the last two in the email chain where it is just her and I.
As of now, I’ve been without medical care for about three months. I’ve received no workers’ comp wage benefits, and I’m unable to qualify for state assistance because there’s no formal record of accepted benefits. My injuries are not improving, possibly from lack of care, and I’m growing increasingly concerned about long-term damage. My current attorney has advised against escalating things with WC, fearing they might stop communicating again, but at this point I’ve lost all hope that this company is acting with any sort of good faith and I feel like something else needs to be done. At the very least, I really believe that this level of dishonesty shouldn’t go unpunished by their supervisors or the state if need be. If I didn’t have my savings to fall back on I’d be in a lot more trouble, but even so this money won’t last forever.
My problem is: If I pull the trigger and start playing offense here it sounds like it might be much, much longer before I see any specialist for my injuries. Everyone has warned me that Workers’ Comp is a nightmare but I never expected this much of a problem. The way I’m feeling right now, I’m very close to pursuing legal action against them as well, but every time I mention what I’m going through in my close circle the consensus seems to be “Yeah they suck but it is what it is.”
Does the state take these kinds of complaints seriously? Does it sound like I am justified to pursue legal action if I decided to go there? It sounds to me like they’re withholding care unless I sign this agreement so they can cover themselves first. I need a realistic opinion before I decide what to do next. I try to never act in the heat of the moment but I’m kind of at the end of my rope.
TL;DR Workers’ Comp is doing what they do best. Would I be making it worse if I tried to hold them accountable?
Embrace - Best wellness plans
My senior kitty is 16. She is/was prone to UTI's, had 3 in 8 months last year, and Embrace will no longer cover anything related to her bladder. She's very healthy otherwise.
The vet saw a bladder stone and she's been on Hill's Prescription food since June, with no incidents since then. I was reimbursed under the wellness portion and quickly used up the funds I had left after her checkup.
Does anyone know of a plan with a high amount of wellness coverage and less amount of insurance coverage?
Thanks in advance!
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