When I call an in-network practice, they usually tell me the next available appointment is in four to six weeks—or that the doctor isn’t taking new patients, it goes without saying all of this is contrary to information updated by my insurance weekly. I push a little or ask about seeing an available doctor, the conversation suddenly shifts to my insurance. As soon as they find out I have a subsidized plan, I sometimes get told they don’t accept it. Is this happening because of recent changes in federal policies, budgets, or staffing? Are providers running into issues processing claims from these plans?

I am in the habit of constantly asking clarifying questions and I ask the same ones over and over again to different people (I call frequently) and I get different answers all the time. I never truly know what's covered or how much it's going to cost. It's so much BS. The medical facilities give me more accurate information than Priority Health does. 3 Priority Health people have told me my son receives unlimited therapy visits because of his diagnosis, but I know that's not true, and I've had only 2 people tell me the correct number of visits he gets for his diagnosis. The pediatric office even knew the correct answer. How is this legal for them to be so wrong all the time? Ughhhhh

I'm 41 and live in New Jersey. I work for a non-profit and make around $35k per year. A few months ago, I saw my GP for a regular check-up and mentioned that, in my job, people often speak confidentially, whisper, or are just low talkers, and I sometimes have trouble understanding them when it seems like there is an expectation that I should not, which can get frustrating. I said that I have not had my hearing tested since I was in grade school like 25 years ago and asked whether that's something that should be checked from time to time. She said sure and wrote me a referral to get a hearing test. So I went to the website for my insurance (Horizon, aka Blue Cross Blue Shield) to search for providers and easily found an audiology office that's tier-1 in my network a few blocks away. I called them, explained that I hadn't had my hearing checked in decades and was looking for a regular test with my doctor's referral, and gave them my insurance information so they could verify that they're in my network. I went for the test, which didn't really tell me much, and later I received the finalized claim notification and was surprised to see that I owe $1,041.85. I argued with the billing department, and then I argued with the insurance company. There are two different issues here, I've been told. First, insurance explained that the medical coding was for a diagnostic hearing test rather than a routine (annual) hearing test. (Obviously, no one ever gave me an option for which type of test I wanted to receive.) An insurance representative talked to the billing department while I was on the phone and was unable to convince them to change their coding; they insisted that they had coded it correctly and that it would be illegal to change it. Insurance doesn't consider it preventive care if it's a diagnostic test, even though their Preventive Health Guidelines document mentions "Doctor will ask about hearing difficulties and refer for further diagnosis" under "Other Recommended Screenings/Tests." When I escalated and spoke with a different insurance representative, she figured out the other issue, which became the main focus: I was billed as a hospital outpatient, not as a visitor to a specialist office. She was not able to change that by working with the billing department and filed an appeal internally with the insurance company on my behalf. About a month later, just the other day, I received a denial of the appeal in the mail. I can still file my own appeal, but I'm not sure how to get a different result. In the meantime, my "payment is overdue," and I'm worried about it going to collections and affecting my credit. The billing department isn't doing anything to hold the timeline even though I've told them repeatedly that I'm arguing with insurance about the bill and had them note it on my file. If I gave the audiology office my insurance up-front, didn't they have an obligation to inform me that the service wouldn't be covered? If I found the provider through my insurance website as in-network, didn't they have an obligation to inform me that the office was considered hospital outpatient and not a specialist practitioner? I should note that I live right by a hospital in a major healthcare city, and many of the facilities throughout the city are under their umbrella. My GP's office is also part of the hospital system. Their name is on the door. I use the same patient portal for my doctor visits as I got this bill through. So why, when my GP is a regular office visit, would this audiology office bill me as a hospital outpatient? I've had health insurance for almost 17 years through my job but only recently started exercising it at all. It's absolutely insane to me that I can be billed an amount like this without anyone letting me know up front that I'm agreeing to pay for a costly service rather than just a co-pay. I'm dealing with some dental stuff right now that's not covered by my plan, and the dentist's office has been extremely clear and forthcoming about costs months in advance. In contrast, this hearing test bill feels like a scam. Does anyone have any recommendations for what I can do from here? Also, does the No Surprises Act help me with this at all?

So my son receives ABA services through a tier 1 provider. This goes through deductible and coinsurance. $650 individual deductible, $2000 coinsurance (minus prescription and copay, solely for him, the numbers mentioned don't apply to family deductible). $0 is covered until the $650 is hit, 80% is covered until $2000 is hit, then 100% covered after. So I call up insurance because last year's bills are much higher than expected. I don't even know the total yet for just last year. And I can't look at the online EOBs yet until tomorrow. So, $650 is covered very quickly. Then there's a $6000 bill (for one date of service) sent to insurance. 80% is covered, we cover 20%. This is where I get so confused. Apparently because the first day wasn't processed first ($11,000) and this $6000 was processed first, she said we are actually paying so much less money overall for the year. We have to pay for the 20%... But it doesn't sound like it counts towards the $2000? We might be paying a total of $4,000-$5,000 once this is all said and done. It went like this... "So if I've already paid the $2,000 towards ABA, why do I have to pay over that?" "Because you're responsible for 20% after the $650 is paid until you reach the $2,000. You're actually paying so much less because that $11,000 wasn't processed first, so you're coming out on top. Otherwise you would have had to pay $2,2000." My brain hurts. I don't know what's going on. That would have put me over the $2,000 and it sounded like he still wouldn't have been considered as reaching the $2,000.... Someone please explain 😭

Location: Georgia, USA Hello everyone- My brother was in a motorcycle accident April 6, 2024. He was in ICU for a month and discharged in July, 2024. During that time he did not have his phone, access to email, or ability to check standard mail. My brother was a PE Teacher and football coach in the state of Georgia for 27 years. All of his insurance premiums were paid for once a month in his paycheck. The state of Georgia agreed to early retirement with benefits beginning July 2024. Blue Cross informed him last month they were dropping his insurance for delinquent payments. His appeal was denied. My brother is looking into COBRA as well as ACA. What steps should he be taking to get the necessary pain medications he needs daily? Thanks!

I’m so disappointed right now, I call them so many times and im denied from badger care ever since I turned 19, I have to make under 15k and 1,200, and also I got fafsa but ik their policies said it’s counted but not really lol, I know I make over it, it still doesn’t help, I don’t know what to do they do give me this random ass number marketplace and should I call them? I’m sorry im so disappointed I feel bad for college students

I had a liver transplant in 2023 at Mayo in Arizona. I live in Oklahoma. I have BCBS of Arkansas through Walmart, where my wife works. Regular lab draws are required and I have a DLO (Quest) and few minutes away from my home. I checked DLO's website which stated they accepted my plan. I got my labs drawn many times over the course of 6-7 months before receiving bills from the lab for the full amount, insurance was paying nothing. After contacting insurance, they said the particular location was not in network. No idea why one would be out of network but other locations of the same company are. However, after conferring with both BCBS and DLO, I was told that BCBS of Arizona is being billed because that's where the ordering provider is from. No one seems to be very helpful on either end as far as getting anything resolved, and there's nearly 20K worth of labs being denied. Does this seem accurate from both the insurance perspective of billing another state's plan as well as why they would deny one location but not another of the same company? Any suggestions on what I should do or how to handle? Thanks!

I had to get ambulance twice between that time my job switched insurance company. Incident was in 4/2024 while I had old insurance, I just got an invoice this January. First notice, now I have new insurance and they aren’t covering it but I have one from January and my new insurance is covering. How do I go about this? I should have been got an invoice from the last year event that happens all the way in April, and just got both because I had an incident in January of the new year.

26, California, $37,000. My health insurance provider denied me access to estradiol for the purpose of gender transition (MtF). I was prescribed this by my doctor and they called me to inform me that my insurance excludes anything under gender related health care according to a denial letter they got from the company. Blue Cross Blue Shield Kansas City provides the health care in Missouri because of the company being nationwide, although I am based in California. I have yet to receive a copy of the denial letter myself, but plan to get a copy of the one from my doctor's office if I don't receive one in the mail this following week from the company. According to the BCBSKS website they do cover gender transition and when I started this job I asked them if it was covered. My H.R. representative seemed confused about the denial and said she'd look into it as she'd never run into this before. She also that they supposedly cover gender related surgery at a certain percentage so something seems fishy. Is this a recent policy change? What are my options? I'm currently filing a complaint through my recently formed union at the company and will be using GoodRx to be able to afford it, but now I'm worried if I tried to receive anything else transition related and am frustrated it won't go towards a deductible. I don't have the letter of denial yet. Will I be able to appeal with information on the letter? Is this legal since I am a California resident or is it all purely through Missouri laws? Just looking for advice.

Hi, first time reddit poster, hoping for some advice. I got a new, much better paying job in Oct. Of 2023 and no longer needed food stamps or medi-cal. I updated my information in both systems (so I thought). California food stamps was difficult because it wouldnt update for some reason so I finally called them and told them to take me off the program. Now, flash forward to 2025 - I've received a letter in the mail saying I got renewed for medi-cal. I did not get this letter last year. And I haven't used medi-cal since I got my job. I checked the website and it still has my old jobs. I've had state medical insurance in Illinois and never ran into this kind of issue. What would be the best course of action to fix this? What kind of penalties could I face? Any suggestions would be greatly appreciated. I haven't updated the application on the website yet, I'm waiting to give them a call on Monday.