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USAA - Insurance for At-Fault driver denying claim bc they can’t contact him
Location: Dallas, TX. I was out of town in November, and my vehicle was being driven by my housesitter, who was involved in an incident where (I believe) the other driver was at fault. She stated she was sitting at a four-way stop when it was her turn to move forward and a driver came through the intersection without stopping and swiped the side of my vehicle. He provided to her his drivers license and car insurance information at the time of the incident.
When I returned from my trip, I filed a claim with his insurance, which was USAA. No police report was filed. I have insurance through Texas Farm Bureau but liability only with a 1k deductible.
The first agent I worked with at USAA was completely unresponsive, I reached out multiple times to her over the course of several weeks before I had any follow up and had to escalate my claim to a manager. Finally, a second agent was assigned. The second agent originally told me that, based on the first agent’s notes, the claim would be closed in my favor, she just needed to verify with her manager because no one had been able to contact the driver.
The next time we spoke, however, she said they needed to speak with the driver to verify events before they could close the claim. Basically, over the course of several months, the driver refused to contact USAA or speak with them about the claim. According to the agent, they sent several letters and calls. I’ve just received a denial letter from USAA and the advice from the new agent is that I file a claim with my insurance and they can try to recoup any monies from USAA; however, I’ll basically just be paying out of pocket bc of my 1k deductible and liability coverage.
I haven’t gotten an estimate on my vehicle yet but the damage doesn’t seem extensive, I would think maybe $1000-1300 in repairs; however, much more than I can afford. Do I have any recourse to get this handled with USAA?
Updated to add paragraph breaks. :) Also updated to say I will double check with my agent about my policy tomorrow (they're closed now). I thought I had liability with a 1k deductible but I'll double check on whether or not thats for collision coverage. I looked at my policy documents and I can't tell what I have...
Thanks for all the help !
Trupanion - Coverage for a Bernese Mountain Dog
Our older Bernese is insured through Trupanion, which has been very easy to work with on hi lymphoma. So far they've covered chemo really well, and we're even considering a stem cell replacement therapy (which costs $75-90k) and it seems like they will cover that as well.
We are thinking ahead for our younger berner, Leela and are going to purchase pet insurance for her. Trupanion has been great for Jackson, but for some reason they are 3x+ as expensive as other options ($600/mo for 90% coverage and non annual limit).
We're also looking at Figo, Pet's Best, pumpkin, and Prudent Pet. Important considerations are unlimited annual payout & a 90% coverage level. Berners tend to get cancer, and we want to make it an easy financial decision to get her the best care possible if that happens for her.
Do you have experience with any of these insurers (or have others that have been good to work with?) Seems like there are many many options, and would like to avoid picking one now that is difficult to work with down the line.
Figo, pumpkin, and Prudent Pet are similarly priced at around $130-180/mo. Pet's Best is coming in way less expensive, $90/mo for a $500 deductible and $55/mo (!) for a $1,000 deductible.
Particularly interested in any of y'all who've gone through cancer treatment with these carries. How has it been?
Health Insurance - Is this fraud? Health insurance added extra funds for prescriptions to my out-of-pocket maximum, but I am concerned it was a system error.
I picked up a few prescriptions in January for a Tier 2/$30 copays. This was a transition fill because my employer switched pharmacy benefits manager (PBM) and the medications were not on the new formulary. They said the lower cost was a grace period and standard of care while appealing for an Exception For Coverage.
A few weeks later my Exception For Coverage for the medications were approved so I paid Tier 3/30% coinsurance on the next fills in February. The Exception For Coverage was backdated to January 1st, 2025. Then, the following month it looks like the PBM reprocessed the January fills as a Tier 3/30% coinsurance and the additional cost was applied to my out-of-pocket maximum accumulator through my health insurance.
I'm not sure what is going on here? I called the PBM and was advised that they will not recoup cost from me and they will not ask the pharmacy to reprocess the claim. The OOP max was never mentions previously, but the representative confirmed that my current out-of-pocket maximum (with the added amount) was accurate as well.
Is this common practice for PBMs? Or, could it have been a system error? Has anyone else had something like this happen to them? I am so confused about this because I have not been billed for the additional increase in coinsurance from the PBM, but it feels like fraud since I know the numbers do not add up.
Horizon Blue Cross Blue Shield of New Jersey - Labcorp submitted incorrect insurance details
Hello,
I have a few questions how to handle my PCP or Labcorp messing up with my insurance details.
I had a bloodwork taken at my primary care and apparently they sent it to Labcorp. But Labcorp billed my insurance with the incorrect details apparently - my name and Member ID, group number are wrong.
I got a mail in Feb asking for insurance details but the return address was not online on their website, so I thought it was phishing. I called the Billing department and asked them if they needed my insurance details, and they said "it is pending with insurance and there is nothing you have to do but wait". I don't have this call recorded.
Today I got the invoice number and it says the below:
"Reason for Bill: We attempted to file a claim with insurance. According to BLUES NJ: HORIZON BCBS, the patient name or subscriber number did not match their records. This balance is now the patient responsibility"
I don't want this to impact my credit score but I don't want to pay $1000 since my PCP or they made mistake that I had nothing to do with. I will call them tomorrow morning but I have a few questions.
1. Since they dumped the responsibility on me, can I sort of force them to refile with insurance? What do I do if they refuse?
2. How long generally do I have to sort this out (not paying) so it doesn't impact me.
Thank you for taking the time to read this. I'm just pretty pissed right now so apologies if I sound rude.
State Farm - Is this normal?
State Farm raised my insurance from $180 a month to $340 over the span of 6 months. Very little and random explanations. My car is 10 years old, it’s insane. P.s. anyone know of good and not stupid expensive insurance in Los Angeles?
United Healthcare - United healthcare prior authorization
I am 20 years old and on my parents insurance. I got prescribed a medication under the impression that they would not be notified but my dad got a call about the prior authorization being approved and also a letter in the mail. Does anyone know how to change this/prevent this happening again in the future?
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?
State Farm - State Farm Homeowner Claim
Long story short.
Storm came thru Pittsburgh region. Pretty moderate wind and hail damage to roof, windows, screens, gutters and downspouts.
Had 2 adjusters that never called me back.
3rd adjuster scheduled a “ladder assist” inspection.
Had 2 seek now inspections. (Needed a re-inspection since first one was done with a wet roof.)
Adjuster 3 said “I put you in for a full roof replacement”.
2 days later I now have adjuster #4 assigned to my case.
Adjuster #4 states “your old adjuster didn’t have the authority to issue you a full roof replacement, management is disputing your claim, we’re having a engineer come out to your house for an inspection, the hail in your area wasn’t that big in diameter”.
It’s been 40+ days since the storm and I have an interior leak…. They just came out 2 days ago to inspect the inside.
Has this happened to anyone else? What’s my next move?
I have pictures of my roof from September 2024 when I had my chimneys re-pointed with no damage.
Now you can tell I have shingles bent from the storm.
It at a loss on what to do.
Edit #1: 1” hail came thru the area.
Edit #2: Correction to edit #1 - Roof is 10 years old. Looking into weather report now. 1.75” hail in my location. 60mph winds. 1/4 mile away a roof was blown off a grocery store. 4 of my neighbors have already had their roofs replaced.
State Farm - Homeowners insurance requirement
Has anyone ever heard of a requirement that a wood fence needs to have 5 feet of metal between the house and the fence for homeowner's insurance? State Farm is mandating that we replace 5 feet of our wood fence that is closest to the house with metal for the policy to go through.
Cooperators - What’s the next best place to get auto insurance other than cooperators
Was just on hold for 4 and a half hours trying to get a quote on my car.. they don’t do quotes in office anymore either…
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