I am scheduled for surgery next week with a specialist. I’ve waited a very long time to get this care and am chronically ill from my health problems. I received notice from the hospital billing department today that in fact the hospital is out-of-network with my insurance. This is after at least 6 months of appointments at this hospital and with this surgeon’s office. My insurance was billed for the other pre-op appointments. The billing office informed me today that I would have to pay about 49k up front to even be seen by the doctor for the surgery at this point. I pressed both my insurance and the hospital as to how this could happen. According to the hospital billing office, they had my insurance numbers but not my card on file (I’m quite sure I gave them my physical cards at one of my in-person appointments). They said someone had entered the wrong plan into the system (one that was covered by the hospital) and just discovered this. Something feels very wrong to me, not to mention the psychological stress of having been preparing for a hopefully life-changing surgery that is likely to be off the table. I have the option to file an out-of-network gap exception or use another recommended surgeon, but I am enraged that this mistake was made. I don’t understand how the hospital could just now find out that my insurance is out-of-network. Can anyone advise—is this fishy? What might I do to get my surgery next week? My FMLA is approved, my friend paid money to fly to stay with and take care of me, and childcare and meals are organized. I find the whole thing unacceptable but don’t know how to advocate for myself. My plan is Highmark Blue Cross Community PPO.

I asked the Doc to send a simple urine sample to Quest. My insurance covers 100% labs with Quest. Today I see on my Florida Blue Cross account they sent it to a different lab and my portion is $3170. What to do?

I recently had a life event (job) that allowed me to change my plan. I chose blue cross blue shield options, because the doctor I need to get a surgery from is in network with them! As of yesterday the hospital in Dallas is not in contract with blue health blue shield anymore.... would this be enough to qualify for another life changing event? This doctor is one of the few specialists that preform this micro nerve surgery. I heard soemtimes hospitals and insurance companies come to agreement and they will start accepting my insurnace again.

My friend in Texas lost her job a year ago and has been on BCBS healthcare through the market place. She suffers from a severely resistant rheumatoid arthritis and her biologics also caused her serious side effects of gut dysmotility and weak immune system. Just yesterday, she told me that she lost all access to her PCP , gasteroenterologist, orthopedic surgeon and psychiatrist, all of which are part of Southwestern Texas Health resources that have been battling withy BCBS over the contracts and stuff. She is applying for jobs left and right but we know how bad job markets are right now. What on earth is she supposed to do? All the doctors she has been seeing are out of network in other available health care plans.

Long story short, I got a bcbs plan through the marketplace last month and I kept getting bills for $0.00 saying I needed to pay or my policy would be canceled. The first time I got a bill for that amount I went online and paid a penny. Then I got another bill for the same amount of $0.00. I figured it was nothing to worry about. Fast forward to today, I have a doctors appointment tomorrow, and I get hit with an email saying my policy with bcbs has been terminated due to non-payment. Non-payment of what? Nothing? Why?

Hello, and thanks in advance for any suggestions. I have a 2024 and a 2025 FSA - for simplicity lets say theres 750 in each. We had a hospital stay for the birth of a child, admit on 12/30/24 and discharge on 1/2/25. Total bill 800. I need to pay the 2024 expenses with the 2024 FSA, and 2025 with the new 2025 FSA. Hospital tells me to contact blue cross, blue cross tells me to contact hospital. Neither FSA companies help. Hospital gave a detailed invoice, but the invoice is a mess and impossible for me to split into services given in 2024/2025. The invoice shows the full charges before insurance. i asked blue cross to provide me with what I an responsibke for, split between the two years so I can call and manually charge each FSA for thier respective years… then pray the fsa will take the invoice as a reciept cus I cant get an EOB split by year… This is all a mess, Im exhausted with a baby and JUST WANT TO USE MY OWN MONEY I paid into these stupid FSA’s. To make it worse my employer chsnged FSA providers so I have 2 seperate fsa companies to submit these charges. Any tips?

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$.

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?

I'm starting a new job in a month. It's remote, and I live in southern Arlington, VA. The health insurance the company provides is Blue Cross Blue Shield of Michigan, because it's a Michigan based hospital. My to-be manager (someone I know from a previous job) lives in Arizona and he said the pickings of doctors have been lacking due to it being BCBS of Michigan and he's in Arizona. I'm wondering if anyone has had similar experiences? Should I take the BCBS of Michigan health insurance (which doesn't cover anything birth control related so I'd have to get something to supplement that) and hope for good choices of doctors in Arlington, VA? Or go onto my husband's insurance with Kaiser Permanante even though it's more expensive?

My ADHD prescription has all of sudden stopped being covered by BCBS TN. What’s the fastest way to contact them to resolve this? I have emailed, chat function not available, and I have now been on hold for 3 hours. Has this happened to anyone else? I’m currently at Walgreens don’t know if that matters. But again, it has been covered in the past. It’s not feasible to pay $100+ for a prescription every month nor do I want to.