I made a claim via triple a and they stated I was at fault for the following: Tire debris was flowing through various freeway lanes. It was not safe for me to merge on to the lane to my left because it was flooded, and to my right there were other vehicles that would not have permitted me to merge in time to avoid the popped tire debris. I stayed in the lane I was an and the debris struck my vehicle, causing damage to the front bumper and fender. They stated I am at fault because I “struck the debris and could have avoided it.” Is there anything I can quote from their comprehensive coverage to not be labeled as at fault? Or am I at fault?

Long story short I was in a car accident and State Farm went from saying my car was a total loss , then now not total loss. I didn’t accept it because my car is undrivable. I have been fighting them for months and I am in process for interviewing attorneys.. I lost my job and my home because I haven’t been able to work without a car. It’s been months. I went onto my account today and I saw a check for $2200 it said supplemental payment. I called and an agent that wasn’t my adjuster, because it’s the weekend & she stated that it was for damage from the car accident that they are paying for. My question is if I cash this check in my screwing myself to go forward and suing them for more money and for what the car is worth.? I know that you can cash a check in New York State and reopen a claim. However, I’m not sure about going forward and suing if you accept the money. I know that on a paper check sometimes it will state that you waive your right to sue them in the future. The paper check would include accompanying documentation often with a waiver stating you release further claims by accepting it. However, it is a digital check. I really do need the money so I don’t know what to do and 72 hours to cash a digital check will be up by tonight, I also noticed on my account that the claim is closed and the car was a total loss!? Any advice on what I should do with this check would be greatly appreciated ! Location: New York

hello! i know my issue isn't major, but I need help as I am desperate to solve this. Long story short, I had medical for the longest time and never had any issues until January when I was informed (when trying to make a dentist appointment) that I had a UMR blockage. I was confused but was told to call medical and get it resolved. I called them and they said to get in touch with UMR whcihc I tried but was beyond useless as they ask for a member ID which I stated multiple time I DONT HAVE, and after somehow bypassing the answering machine UMR tells me they have no records of me ever existing and to basically die in a ditch as they just hunged up on me. I explained this to medical, and they made me fill out a form to remove "other healthcare coverage," and it should be removed (I did this twice, btw). It in fact was not as I tried to make a dentist appointment again and same thing: "UMR blockage. please take this up with medical". I called medical again, and they gave me a case ID and told me to ask UMR for a "coverage termination letter," which I tried to do, but again, they told me, "We don't know you we can't do anything" and hung up on me. I explained this to Medical, and they filled out a form (the same one I did), and it should be resolved, yet I don't know if it actually be. Also, worth to mention one of the workers I spoke to told me that the UMR policy I was under was my uncles, whom I have had no contact since like five years ago and have no connection with at this point, the alleged policy began in 2023 so I don't understand how this even happened:C when I tried to report the fraud to medical they said "you cant report it here, report it to UMR and then we could try to remove the block because until then we cannot remove an active policy by law" But UMR has been beyond useless and I'm scared because I have a cavity and I know its not serious but I am afraid it could get worse Im just trying to see if anyone was in my same situation (which is very unlikely) or if I could get any recommendations on what to do because I don't know how to proceed anymore and this just pmo. Anyways thank you to whoever read this and pls help

Cigna denied my claim for a “periodic oral evaluation-established patient”, but approved adult cleaning (two per calendar year). This was the second examination and cleaning I got in the year. Reason for denial is “N4 - This claim is denied due to lack of information. If you would like to have the claim reconsidered, please submit the information requested” I contacted Cigna customer service twice and both agents said they didn’t know what the information requested was and provided no course of action. Who can I reach out to to understand what additional information is requested since Cigna doesn’t know?

Couple of questions if I may... I recently used Goosehead to get home and car insurance. They said that AMWINS would be best for homeowners insurance. Has anyone heard of AMWINS? Are they any good? Anyone had any claims with them? Also, I just received a notice of a rescind of cancel notification from both of them. I never received notice of cancellation and that is concerning to me. They stated that the original reason was "underwriting". It does state that there was no laps in coverage. I will call them later today but I was wondering if anyone could shed some light on this as to what happened. I live in DFW and the house is paid off if that means anything.

This question is more a curiosity than anything. I have a dead 25-30’ tree leaning towards my house and an arborist confirmed it is an imminent to my home and must be removed. When I contacted my homeowners insurance, they said they would only cover damage to my roof if the tree fell, but wouldn’t cover the removal of the tree. What’s the logic behind this? I’m sure some actuary determined it just cheaper to deal with the roof, but the face value cost of replacing likely my entire roof versus the cost of removing the tree it seems like a no-brainer. I’ve already accepted that I’ll need to pay for it, I’m just curious if any insider insurance folks can clue me into the reasoning here. Thanks! ETA: Okay, I get it now. Thanks to all the folks who gave helpful responses, it cleared up a lot and might have saved me from a big headache!

My dog is 7, I've had her on Nationwide's comprehensive plan since she was 6 months old (they reimburse 90% for anything performed or prescribed by a vet after hitting $250 deductible), and of course I've heard the stories about older-ish pets on these old plans getting dropped without warning. I'm trying to prepare for us getting dropped, I'm just still very undecided as to our next best option. She has a history of bilateral ccl tears and we did tplo's on both legs. She will probably have arthritis because of this plus any potential hardware removal necessary (no problems so far, I just know it's a possibility). Besides that, she (knocking on all the wood) hasn't been diagnosed with any chronic conditions. I've been looking at AKC since they cover pre-existing after 365 days, and I want to get her signed up fairly quickly so we can start the clock on 365 days, plus I think I read that they don't take dogs on that plan 9yo and up. But even AKC's plan lacks a lot of the preventative coverage I have now, even with the add ons which do increase the premium quite a bit. I know i always have the option of putting my would-be premium into a hysa every month and just paying for everything myself. I'm just so scared of getting hit with bills that will outpace my savings. Has anyone else been in this situation and found a good alternative? I know I've been a little spoiled with nationwide, but I did sign her up early thinking I would have her covered for life. Thanks in advance!

I did my due diligence and found a provider listed on the BCBS website listed as in-network. I verified with insurance and the whole nine yards. However, when BCBS adjudicated the claim, it was processed as OON to my surprise. When I questioned why, I was told the provider used a different NPI that is OON. In all seriousness, how is a patient supposed to know what NPI a provider bills under? Do I have grounds to appeal the OON determination or should I ditch this provider and find someone else?

TL;DR: my 8yo DSH cat has "slightly abnormal shape to heart," "discussed URI, allergies, etc.", and "susp. feline idiopathic cystitis" written in his vet records, all from different exams and illnesses over the last few years, but with no recurrence in illness or symptoms. Are these comments enough for insurance companies to say he has incurable preexisting conditions and deny coverage of any future health issues? I'm super late to the party (no one told me to get pet insurance when they're young), but I'm looking to get insurance for my two cats, Andy and Ollie. Given that they're basically my children and I'm finally in a position where I have a bit of income, I want to do what I can to make sure they're able to get whatever care they might need (though hopefully they never do). Both are 8 year old DSH, previously indoor/outdoor for 3 years, now indoor only, no major health issues so far (no ER visits, no chronic conditions, etc.). I've been spending a bunch of time reading up on different companies, policies, reviews, kinds of issues people run into, etc., spoke with an ASPCA rep and planned to call Lemonade and Pumpkin to ask some questions and compare rates and plans and such. With all the frustration and confusion expressed different places about claims being denied for preexisting conditions, I decided to read back through the vet records I have and see if there was anything that my cats might get dinged for. There are a few things off the bat: they're both a bit on the chonky side, but weight has been steadily coming down into good ranges. A vet noted mild tartar two years ago, which I know means there's essentially no chance of any kind of dental coverage, but that's not necessarily the end of the world. What's really got me worried is that Ollie has had a few illnesses that I could see insurance companies labeling as preexisting conditions and using to deny future coverage: * May 2024- After a wellness exam where the vet said he was in good health, he became lethargic, struggled to use his litter box, and barely ate. I got him back into the vet ASAP, and the doctor found his bladder was painful and a little swollen, diagnosed "suspected feline idiopathic cystitis (FIC)", and gave him an anti-inflammatory shot and gabapentin. Ollie responded well and recovered in a few days with no issues since. Importantly, the vet noted that the inflammation could have been caused by stress and that his bladder was full but "did not seem to be blocked" -- I know that urinary blockages are considered incurable preexisting conditions, so I'm worried that the lack of definitive language (ie "no urinary blockage") could provide enough wiggle room for them to call it an incurable PEC. * July 2023- This is the one I'm most worried about. I took them in because Ollie had been wheezing a bit after activities like playing with his brother. At some points, it sounded almost like he was trying to get a hairball out, but nothing ever came up. The vet ran some tests to check for heart disease, asthma, or a URI. His radiographs showed "no obvious signs of asthma" and "weren't a slam dunk for asthma", but unfortunately did show "potential heart issues, abnormalities on heart" and specifically that his heart was apparently a "slightly abnormal shape". She recommended a proBNP to see if his symptoms were heart-related and it came back negative, so she said it was most likely a URI and gave him antibiotic and steroid injections with instructions to come back for a trial asthma treatment if he didn't improve. Thankfully, he did improve and hasn't had any wheezing since. -- This is especially concerning because 1) asthma is an incurable PEC and even though none of his vets has ever diagnosed or trialed treatment for it, the fact that asthma was even mentioned could be enough for them to call it a PEC; and 2) the "slightly abnormal shape" of his heart just screams guaranteed denial of coverage. And if this is considered an incurable PEC, what kind of probably serious things could they potentially refuse to cover because it's tangentially related to his heart? * Also, Ollie is a snorer. It's never gotten to a point where he's stopped breathing or anything, but it was happening frequently enough that I brought it up at a wellness exam. We used to live in a house that got fairly dusty, so I asked the vet if allergies might be contributing to his snoring and if an air purifier might help. The vet records read "Disc informed O about URI, allergies, etc.". Really really hoping that me asking about allergies doesn't lead to a future issue not being covered. So yeah, I feel like there's enough in his records for insurance companies to reject so many different kinds of claims, especially claims for cardiac, respiratory, or renal health issues, by saying these illnesses (and snoring) are evidence of incurable preexisting conditions. One of the big reasons I want to get insurance is in case cancer tries to rear its ugly head, especially since both of my childhood pets died young from cancer and all my family could afford was basically just pain management. I don't want to go through that again with my boys, and there are also a ton of other big health issues that could pop up and (hopefully lmao) be covered by insurance. But as much as I want to believe that they'd be reasonable, at the end of the day, these insurance companies aren't non-profits, they exist to make as much money as they can, and there's no Pet ACA to prevent them from denying coverage because of preexisting conditions. Which brings me to my main question (sorry for taking so long to get to the point): is getting insurance for Ollie worthwhile? I'd hate to spend the money on fairly pricey premiums just for anything that might come up to not be covered. Maybe I'm just overly worried and cynical, but the fact that something small can make a massive difference in how much longer I get with my fur babies is honestly scary. Sorry again for rambling, there's just a lot to consider. Any advice or insight is very much appreciated!

TL;DR: Employer canceled insurance benefits without notice while on FMLA due to nonpayment, despite efforts to pay. Hi, there. I’m currently on a medical leave of absence from work, and have been experiencing some difficulties with my FMLA/insurance benefits. I’m new to this, so any input would be appreciated! My leave began the last week of December and I’m set to return on 3/24, the last day of my FMLA protection. Since my leave started, my main priority was getting my insurance premiums taken care of so as not to lose my benefits, especially since I’ve racked up substantial medical bills over the course of my leave. I reached out to my benefits department, and was instructed to reach out to a third party (WEX) to make payment, which I did. WEX informed me that there was no balance due reflected on their end, and to reach back out to benefits. This back and forth has gone on for months now. At one point, they told me to reach out to BCBS to make payment, and BCBS acted like they had no idea why I was directed to them in the first place. I’m over 10 weeks into my leave, and have not received a single correspondence about my health insurance until today. Not a phone call, email, or letter. I did, however, receive a bill from WEX for my vision and dental coverage, but nothing whatsoever in regard to my medical coverage. Once I received the dental/vision bill, I called same day to make payment and was told, again, that there was nothing in the system to apply payment towards. Reached out to my benefits department again, and they said they could see the unpaid premium for my dental/vision. Called WEX again, and after escalating and speaking with a supervisor, was told that the reason why I was unable to pay my dental/vision is because the plans had been cancelled due to nonpayment. When I reiterated several times that I’ve been trying to pay for quite some time by that point, I was told that if I mailed the payment ASAP, there is a “strong possibility” they might reinstate the plans. I mailed the check the following morning, and am hoping it works out in my favor. What I’m most concerned about, though, is my health insurance. I spoke to someone in our benefits department in February, and was told that because I’d exhausted my PTO the first half of January, my insurance premium would have been deducted from one of those paychecks. According to the representative with whom I spoke, “January was covered.” I told him I’d received bills for my dental/vision coverage, but still hadn’t received anything for my health insurance. He told me to just wait a little bit longer for it to show up in the mail. Over 10 weeks later of non stop calling and trying to stay on top of things, and I still haven’t gotten anything. I expressed that due to the nature of my leave, I really needed to keep my insurance coverage, and was terrified the third party was going to cancel my policy for nonpayment. He reassured me that the only one able to cancel my insurance would be my employer, and they would “of course” provide me with ample notice prior to that. When I told him it didn’t make sense that I’d receive bills for my dental/vision but not my health insurance, he told me to not worry because my health insurance will remain as is regardless. That my account would just go in a rears and my employer would deduct the unpaid premiums accrued during my leave from my future paychecks once I’m back to work. A supervisor from benefits called me today (10 weeks after my initial call), letting me know that the reason why WEX didn’t have my balance due in their system was because my health insurance was cancelled on 1/28. When I told her that I’ve been calling for help for months now, and continue to get the runaround, she just kept saying it was my responsibility to cover my premiums while on FMLA. When I told her that benefits told me no one would cancel my health insurance without notification, she disregarded it. Same when I mentioned the rep telling me that my account would just go in a rears and they’d deduct the premiums from future paychecks. She told me that I owed for January, February, and March, and that there is a 10-day grace period where I can get caught back up to “hopefully” have my coverage reinstated, but couldn’t be for certain. I checked my last paycheck from January, and the deductions are reflected on it. I’m just very confused because she was adamant I owed for January still too. I just don’t see how they can cancel my insurance: 1. Without notice, and 2. After I’ve made an effort to get it paid since the very beginning of my leave. Someone had mentioned this being problematic because of potential FMLA violations, but I’ve never gone through this before and I’m honestly unsure of the process, and obviously don’t feel comfortable reaching out to my employer given the misinformation I’ve received thus far. Our market is experiencing mass layoffs right now, and I was hesitant to go on leave in the first place because of it. I don’t know if it’s worth mentioning or not, but the day before my leave was set to begin, thought to call Alight just to make sure I was not going to be reprimanded for not coming in. The representative informed me that my LOA request had been cancelled. This gave me pause, as the only ones who knew about the LOA request was my immediate supervisor and Alight. I’d have been no call, no show and subsequently terminated had I not thought to call beforehand. I’ve just been worried so much about all of this, and honestly regret taking the medical leave even though it was necessary. I’ve spent more time going back and forth with my employer than I have with my physicians and it’s been hell. Does anyone have any input regarding this situation? Is this just an HR issue and nothing more or should I consider seeking legal counsel? Thanks so much ❤️