(Head's up this is a long one) So, I recently got a letter in the mail saying I had a late payment for my healthcare premium although I've set up auto-pay and only recently got it reinstated in February. After calling customer support last Friday, they explained that after looking at it my old (terminated) account was still showing as active and was registering that I had been delinquent on those payments and that was the reason I had received the late payment notice. They told me I actually owed $0 and it was a system error. So, I went ahead and paid my rent early and put it out of my mind thinking it had been solved. WRONG! I then got a call yesterday saying that actually, "upon reviewing your account" I actually did in fact owe $999 by the end of the month or my account would be terminated. Is that not crazy? Are tIhey really that money hungry? I've filed a complaint with them but other than that, what else can I do? I'm considering just letting my account terminate, backpay for the one prescription I received and just starting new coverage next month but will that reflect poorly on me? I'm just not sure what else to do.

I have UHC and while taking care of some things on the phone with a representative I asked a question out of curiosity which was just my confusion that sometimes when I get my botox for migraines my provider has me pay nothing and I get the bill later, other times I just have to make "a" payment and then get the bill later. When I say get the bill later in both cases I mean after the claim has gone through insurance I then get the billed amount I owe, and the portal for UHC updates with my EOB (I use the EOB to apply for a savings program to be reimbursed by a third party). My most recent appointment however they made me pay the full amount of botox up front otherwise they refused to treat me. I am disabled without this treatment so I just found a card with enough money on it and gave it to them. The insurance representative told me they aren't to make me pay more than a voluntary small amount of my choice if I want to, and that they aren't supposed to deny me my treatment that they approved. She told me to not pay next time and if they push back to call United and get a representative on the phone. My mother used to work medical scheduling however and she insists they can make me pay whatever amount they want and reimburse me later. I am thinking my mom might be more right but just want to hear it straight. For the record I am in the (slow) process of changing migraine treatment providers for a number of reasons related to poor communication or miscommunication.

We were uninsured for awhile, and honestly, it wasn't that bad. We had a 94% discount from the hospital we used and had a great experience with them for many years. Fast forward to last year, we officially got insurance. Cigna. We have an HSA account and a high deductible. We spend SO much money, but I view this as paying for peace of mind so if anything horrendous happened we would be covered. Now, I just got word that our hospital is discontinuing service with Cigna and everything is going to be considered out-of-network. This is a blow to our family because 2 out of the 4 of us require specialists. My son is medically complex and the hospital has a children's hospital wing where he sees 5 specialists a year and may need surgery in the coming years. I've spent years finding a medical team that works for our family and they're all at this establishment. It's all being pulled out from under us...it takes effect in 3 weeks. I don't know what to do now....should we go back to being uninsured? How do we shop around for insurance? Should I look into catastrophic insurance? A friend recommended US Health Group but after searching this sub I'm hesitant. Key points: 1) We make too much money for any form of government assistance (however, we are NOT wealthy) 2) We live 2 hours away from the next closest children's hospital and I have yet to find out if they accept Cigna. 3) How do I vet an insurance company? TIA

Hi all, thanks in advance for reading this. My situation is this: I’ve started a new job that had 3 options for health insurance. All were blue cross blue shield. 1 option was no hsa but in and out of network coverage. 2 options had hsa’s but one had in and out of network coverage and the other didn’t. I figured I’d get the was with a hsa and no out of network coverage. BCBS is very common where I live and figured no issues. Well, my son had to have surgery but before hand, we gave our new insurance to all the doctors and they said they accepted it with no problems. After the surgery, we received a $16,000 bill with a statement saying all procedures are not covered because we didn’t use in network doctors. So I make some calls and come to find out the nearest doctor or hospital that is in network is 2 hours away! Nothing around me is in network!? BCBS told me I should have chosen the insurance plan with hsa and out of network coverage. I have a 18 month old and a wife. I can’t wait till open enrollment to change health plans… what do I do?

I’m going insane trying to get my dental benefits sorted out with Cobra. I paid my Cobra on 3/8 (first month) and MetLife made my plan active, backdated to 3/1. On 3/12 it was canceled again. 3/15 active again. 3/17 canceled again - MetLife said call Cobra servicer. Servicer sent in a reinstatement and it was active again on 3/19. I log in today and it’s cancelled 3/24 AGAIN. I paid for a month of benefits and I haven’t even been able to use them. MetLife acts like it’s the servicers fault. Cobra just sends in reinstatement notice. Repeat. What do I do in this situation? I have oral surgery in a month and god only knows if it’ll be active or MetLife will decide to cancel it on that day. How do I go about escalating this?

I reported a provider to my ins co for balance billing. The provider wanted me to sign a waiver allowing them to balance bill me. I asked the rep if this waiver is illegal, and/or would it get the provider kicked off for violating their contract. I really couldn't get a straight answer. I was just told that unfortunately a lot of providers do this, and there's no guarantee of what will happen to them. Is it worth it to also report them to my state's insurance division? I don't want to waste my time if these balance billing waivers are legal.

Hey all, I’ve been having issues with my insurance trying to approve a surgery. My surgeon submitted a prior authorization and they denied it. They resubmitted it with a different diagnosis to meet the criteria. They usually take 5-10 business days. But within 48 hours I checked my UHC account and it said “cancelled”. What does it mean when it’s been “cancelled” and not actually denied? I have United Healthcare through my mom’s work. Thanks!

I'm filing taxes for the year 2024 and I found out we had marketplace coverage that we didn't know we had. In 2023 my wife began the process of applying for marketplace coverage, but during the process told them she was no longer interested and that she wanted to cancel her application and for them to delete her information. We have now found out that they did not do that and instead completed the application and we were enrolled for the first 3 months of 2024 before my employer health insurance cancelled it. Is there literally anything that I can do? It doesn't seem right that we ended up enrolled for something my wife cancelled midway through the application process. For context, the reason she wanted to cancel was because the representative felt hostile and she had almost fallen prey to a handful of scams, and he kept rushing her to give him her personal information so he could finish. She felt his tone was more in line with scammers rushing marks to get the payoff and tried to terminate the interaction and the application immediately.

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.

At the end of 2024 my wife visited an allergist to try and get a handle on her allergies. A boat load of testing later and she needs allergy injections for her horrific environmental allergies to attempt to get control of them. Everything is good with this allergist at this point. It’s the end of December 2024 and the allergist informs her at her appointment at the end of the next month (January 2025) she will owe $1500 to start her year long series of injections. We have a HDHP with HSA so we totally understand that cost because the deductible resets. Well life punched us hard over the next month and my wife has ramped up her attempts to find a new job because she is so unhappy at her current one. Given everything going on and the fact that she isn’t sure if she will continue to have the same insurance or access to the same provider to complete the allergy injections if she gets a new job, she decided now isn’t a good time to start the allergy injections. So she cancelled her appointment 48 hours prior to the scheduled appointment. This provider did not give her any kind of verbal, written, mimed, carrier pigeon, etc policy related to appointments, billing, and/or payment policies for the practice. Nothing. So at the beginning of February 2025 she received a bill from Quest for the bloodwork she had done in December 2024. Two of the bajillion tests requested by this provider were not covered and it was going to cost us almost $700 out of pocket (whole separate issue we’re handling). She couldn’t find an EOB so I told her to log onto the portal to see if she could download it. Well she logs onto the portal and there are $2,000 worth of claims submitted from this allergist in mid January 2025. They were not the claims related to her appointments in December 2024 and they were submitted two weeks before she cancelled her first allergy injection appointment. To make a long story short, the allergist prepped the injection two weeks before my wife’s first allergy injection over the course of 3 days and submitted the claim to insurance for it. The doctor’s office is saying she is responsible for the bill and I’m saying that sounds like fraud for billing for treatment she never received and was prepared without any kind of contract or informed consent to give her the opportunity to prevent this from happening. My wife has spoken with 2 different insurance reps and one was like yeah you’re responsible and the other said I’m referring you to our fraud department. The doctor is entirely unhelpful and has refused to communicate with her on 1. Why there is no practice policy to avoid this situation and 2. How long that injection mixed up in good for and 3. What happens if she stops doing the injections after one appointment. What do we need to know about this? Is this fraud? Should we push to not be responsible for this cost? Did my wife make a mistake somewhere in understanding how allergists operate and missed what is the obvious to the field she should have cancelled her appointment at minimum two weeks before it was scheduled?