My daughter is going through a lot of PT/OT that is being billed via a local hospital outpatient center. I talked to the insurance company administrator for this portion of my insurance and I ensured that the provider (hospital) we were going to would be treated as in-network (see \*\*\*\* paragraph below, as they guaranteed it and I couldn't find a provider that would do this within 30 miles of my home). To do this, they had to negotiate and worked out an agreement. On top of this, the provider has to get pre-authorization in blocks of visits so no visit has occurred without someone at the insurance company pre-authorising these. My certificate of coverage does say that I do have PT/OT benefits but there's two kinds of it, one that is based on a hospital stay and one that is based medical necessity . They both have the same copays and costs, so it shouldn't matter but regardless, there are two ways one can get PT/OT via my insurance plan. The provider has submitted these PT/OT requests to the hospital administrator Anthem. Anthem has rejected these with the code: "\*00NYP Your policy will cover this service only if it follows surgery or a prior hospital stay for the same condition. Please refer to the section of your contract or benefit booklet that describes the coverage for this type of service." \*\*\*This is what my certificate of coverage at a glance says about CT/PT/OT: "Chiropractic Treatment, Physical Therapy and Occupational Therapy Network Coverage Each office visit to a network provider, including related radiology and diagnostic laboratory services, is subject to a single $25 copayment. No more than one copayment per visit will be assessed. MPN guarantees access to network benefits. If there are no network providers in your area, you must contact MPN prior to receiving services to arrange for network benefits. Therapy must be prescribed by a qualified provider." AND "Physical therapy following a related hospitalization or related inpatient or outpatient surgery is subject to a $25 copayment per visit. Physical therapy must start within six months of your discharge from the hospital or the date of your outpatient surgery and be completed within 365 days from the date of hospital discharge or outpatient surgery. Medically necessary physical therapy is covered under the Managed Physical Medicine Program when not covered under the Hospital Program (see page 12)." From looking at how they are capitalising things, I believe Managed Physical Network/MPN is yet another administrator for PT/OT like United Healthcare, Anthem, and Carelon for medical, hospital, and behavioral. Am I right? So they are not sending it to the right place? Or it is coded incorrectly? I'm wondering why this provider is having so much trouble getting reimbursed the right away since there's been a lot of communication already with SOMEONE and it should all be set.

Hey everyone, I had a question regarding auto insurance with Progressive. They sent me a memo via email and asked me to call them about folks under the same roof as me not under my insurance. I called them and explained that I declined coverage for all my family members under my roof, for the have their own insurance. They said I still need to "pay" to have them declined under my coverage. I asked the girl over the phone why I need to pay to decline them coverage on my policy. She said it's in case they're passengers. So let me get this straight, they want me to pay $93+ to state all my parents and siblings are declined on my policy? Even though NO ONE drives my vehicle. Is this legal? They said they're mailing me a document via mail for me to sign and get back to them to continue coverage.

Healthy Paws just raised our pet insurance to an extra $100 a month out of no where! Has anyone else gotten a huge rate hike like this from them? This is Absolutely ridiculous.

I had surgery on May 8th. At that point, I had not yet met my deductible or out of pocket max. I was told that I would owe $3,500. $150 to go towards my deductible and the remaining going towards everything else. I paid them $2000 as a deposit before the surgery leaving me with a balance of $1,500. I was told at that time that as long as everything was covered by my insurance. If at any point I met my max out of pocket, that I shouldn’t owe the hospital any more money, even if there was still a balance remaining. I also had another surgery on May 12th. I knew that between both surgeries, I would cover my out of pocket max for my insurance. I got two bills in the mail about a month later one for the first hospital for $1,500 and one for the second for about $2,000 I called my insurance and explained that I met my max out of pocket so I shouldn’t owe anything. They said they submitted claims to both hospitals and that it should be taken care of. I was still receiving bills for both hospitals so I called my insurance again and they said that the second surgery was covered and the claim was being finalized but that they weren’t seeing anything for the first surgery as far as claims go and that I needed to contact the hospital and have them give my insurance a call. I contacted the hospital and they said they would not contact my insurance because everything looks right on their end and that my insurance needs to contact them. I have since contacted both my insurance and the hospital and they are saying that the other needs to be the one to call and that “we don’t call them, they need to call us.” The only thing is that the hospital suggested that maybe I put them on a 3 way call. Anyone who knows about insurance and what I should do, please help. Also I’m sorry this is so long 😅

Any tips on companies offering good pricing? Progressive is charging me $250 monthly - zero accident history or violations in 7 years - 29 year old male, 2016 Camry )

Hi everyone, I’m a female in my late twenties, not pregnant, and I live near Bowling Green, Ohio (Wood County). I’m on Buckeye Health Plan and have been with them for about 3 years. Overall, it’s been fine. I like their 24/7 nurse line, free dental coverage, and that they cover out-of-state ER visits. I travel a lot to Florida, so that’s been very helpful. That said, I’ve noticed some limitations, especially when it comes to finding mental health providers. Another limitation is medication coverage; sometimes, even when the generic version is unavailable, it’s still difficult to get the brand-name approved. I’m considering switching to a Medicaid plan that offers more options and benefits, especially in case I face bigger health issues like surgery or serious illness. From my research, CareSource, AmeriHealth Caritas, and Humana Healthy Horizons seem to have the best options. I also like when plans are good with technology and keep their websites up to date. The problem is, after searching Reddit and reading different posts, the opinions are all over the place. Finding a provider is not a problem, and I’ve already read what each plan offers. They all seem good, so that didn’t help narrow it down. I just don’t want to switch and then be stuck with a plan I don’t like for another year. I’d really appreciate hearing from anyone who has experience with these plans and could recommend a good option.

I recently had to have an in-patient EEG. The neurologist said they'd call my insurance (Aetna) for pre-approval before moving forward with booking. I received a call saying that it was completely covered and to move forward with procedure. I check-in with no mention of payment and checked-out with no mention of payment. Cut to now about a month later and I receive a bill for $7,000. Apparently, insurance only offered partial coverage though I was told by my provider it will be completely covered. Do I have any recourse in this?

Hey everyone, This is a follow-up to my earlier post about trying to cancel my Wawanesa auto insurance (I’m the guy paying $750/month for a commercial plan meant for Uber Eats, which I barely do anymore). My regular broker had gone silent for a while, but I finally got in touch. Here’s the update:- My broker confirmed I can cancel the policy early. However, he says I’ll have to pay two months' worth of premium upfront as a penalty — that’s around $1,500. The new policy I’m eyeing (with TD Bank) is non-commercial and about $450/month, but they also require 2 months paid upfront to start coverage — that’s another $900. So basically, to switch policies, I’d need to cough up $2,400–$2,500 upfront, just to get out of this $750/month cycle. Now I’m stuck asking myself: Is it even worth switching, or should I just suck it up and keep paying monthly till my current policy ends in November? Will I even save enough in the long run to justify the upfront hit? Has anyone else dealt with a similar situation — switching from commercial to personal auto insurance mid-term? Any creative options or negotiation tips I could try with either Wawanesa or TD? I’m still trying to be financially smart here — just don’t want to end up spending more just to spend less later. Appreciate all your input!

This past Sunday, while watching a movie at a theater, someone ran over brand new my motorcycle in the parking lot. Thankfully the person who did, told an employee and waited for me. He gave me all of his information. I filled a claim with his insurance, The Hartford and am a little worried about it now. Within a day of filing the claim, they have switched the adjuster and the new adjuster told me, “honestly, I don’t know. I’m not going to ghost you…” when I asked for a timeline on them getting back to me. Are they just going to give me the run around?

I went to NYU langone raadiology lab (its inside hospital) for a ultrasound before the ultrasound i looked up the cpt code on the bcbs website and it gave me an amount allowed of like 200$ before deductions, and i was okay with that now i got the bill, and the amount allowed is like 900$ i called the insurance and they said its because the lab billed under the lab but not the doctor itself -- the amount estimated on the website is under a doctor . bcbs does not know what is the amount allowed under the "lab" i dont know if this is normal, but it was my first ultrasound and i dont know what to do. if i ask nyu langone to bill under a doctor will they do that? it was just intern/PA that did my ultrasound so does that even count? what should i do in this case?