We have been on medi-cal since 2020. Husband and I both lost our job. When we started working, we reported our income. We had a child and our income still within theamount that qualifies. 2022, I reported my income. And they still renew. 2023, I did not work, we qualified. 2024, I got a new job July, I called and they said my medi-cal will be cancelled by August. I enrolled in my job's medical insurance. Fast forward 2025, got a letter we qualified. I kept in my record that I always submit proof of income. What should I do?

Hi everyone! I appreciate any and all answers here. So I just filed my taxes for 2024 and my HR Block representative said that she urges me to switch from Covered California as soon as possible. In 2024 I had medical issues that caused me to lose my job so I switched from employer provided insurance to Covered California starting last May 2024 with the cost being $94/month. Then in August 2024 I got a new job and received a significant pay bump ($21/hr to $31/hr) and I did not know that I was supposed to report my new income to Covered California. In December 2024 after my surgery (to deal with the aforementioned medical issue) I contacted Covered California about renewing for 2025 and during that conversation I found out that I was supposed to report my income change. That led to my rate increasing to $294/month and the worker told me that I will also be facing a tax penalty and backpay for not letting them know about my new monthly income. When I prepared my taxes a few days ago she revealed that the backpay was a total of $1,100 and she said that she's seen this with a lot of her clients and even herself. She stated that with my line of work I will most likely earn more than I anticipate this year and will most likely pay even more taxes to the IRS with Covered California. She urged me to get on a new health insurance plan asap. **My current options are to contact the company that I work with (it's a third party company that I get pay from as a contractor even though I work full time hours). OR I can contact individual insurance companies and try to just get a rate directly with them.** **My questions are** **1) Am I even able to switch my insurance this late into the year? I don't have a major qualifying event aside from just wanting to leave Covered California.** **2) Are the options that I mentioned above correct or are there other solutions that I am not aware of?**

In the past I never remember paying anything for an annual physical with blood work. I recently received my bill and my blood work/urinalysis was $1206 and after cost reduction I owe $1020.cigna covered nothing and I will have to call them and see exactly what they cover because I will be turning down the blood work for now on if this is what it will cost. General health panel (CPT 80050) $630.99 Blood test lipids (cholesterol and triglycerides) (CPT 80061) $293.80 $20 for the needles and stuff I rarely go to a doctor so maybe I'm out of the loop but everyone I mentioned this too says it doesn't seem right. So I wonder if it's a coding issue or Cigna really just doesn't cover anything until I hit the $1k deductible.

Long story short, I recently got a grant for my son who has autism spectrum disorder and was able to find a provider who had social skills therapy for him. The grant will reimburse me costs 100% however they need a copy of the EOB. I found a provider who was out of network but was the only one offering this therapy in the time period I needed it. She was upfront saying that we would have to file our own claim which I have no problem with. She provided the superbill and all of the codes. Well today I logged into UHC to try to submit a mental health claim and the form is not available, then I called them and they told me that I cannot submit my own claim. I told them that my provider does not file claims but they were insistent on saying that the doctor would have to file them. Is this a common practice? I am just frustrated.

I have a question about prior authorization. I am trying to get one of the weight loss meds like wegovy, zepbound etc. I had several appts with my primary care Dr and she informed me she would try but that most likely insurance wouldn't cover it. The Dr office called me today to tell me about bloodwork, etc and informed me I should call my insurance provider and ask if it would be covered. I did that, with blue cross blue shield, and the lady on the phone was extremely helpful. She informed me ozempic and something else wouldn't be covered but wegovy and zepbound are and she would need prior authorization. She put me on hold to call my Dr, then when she got back on the line she said the Dr would not do prior authorization. She also informed me I should find a new Doc because your Dr is supposed to help you. My question is why would my Dr then deny it after asking me to call and see if it's covered and it was? I'm just confused. Thank you for any insight.

I need advice on how to negotiate a bill that I received from my insurance. I had a neck and upper shoulder pain for more than a week and I went to a specialist. He did some routine range of motion checks and just advised to avoid the gym and use a heat pack. Now I see I've got a bill where Aetna was billed $1155 for the office visit and my bill is $375.76 which is around 30%. This seems like a very high charge for a 10 minute routine appointment. Is there any way I can either ask for a reduction on what Aetna was billed or what they charged me? The latter seems less likely since I haven't hit my deductible yet Edit: This is NY state and the appointment was at NYU Langone

Hi all, I'm leaving my current job and I have another position that pays higher than where I'm at right now, but no employee health plan. I'm in CA. Right now I'm looking at marketplace plans for my spouse (33M) and I (31F). We don't use much when it comes to health care. A few random visits here and there, I take a few daily mental health meds but that's it. However, we do want to start a family in the next year so I'm trying to keep that in mind. I've always been on an employer PPO, so that's what I'm used to. My top options currently are Blue Shield of CA PPO, or Kaiser Gold HMO. From what I've seen blue shield is one of the few companies that will offer PPO on the marketplace. I've looked at some of the cheaper plans through multiple companies but since most of them have coinsurance, I worry I could rack up quite a bit if I were to get pregnant/deliver. We earn too much to qualify for financial help/ACA plans as well. Here's my question - how much does Kaiser's HMO plans differ from their PPO? Is it really a big difference since it's all in one system? I know there are issues with Kaiser and it seems people either love it or hate it. But it seems like their HMO plan is cheaper with better coverage (particularly for maternity) than a similar PPO through blue shield. Anything I'm missing here? Any advise or prior experiences would be helpful.

I live in the states in Indiana. I went to my doctor this morning and used my insurance card fine. They prescribed me meds, I went to CVS and they are saying my insurance card is not working. I called ambetter and they claimed I got a new ID number, I gave CVS the number and they said it's still not right. They gave me another number and it's the same as on my insurance card. What is going on? I have a feeling CVS is messing up but maybe it's Ambetter??

Hello. In December 2024 I enrolled in health insurance with United Health care through my employer during open enrollment. Benefits were to begin 1/1/2025 and my premium was to be $54.44. I noticed on my recent paycheck that my premium had more than doubled. I never received notice of this premium increase and only realized it had happened because my paycheck was smaller. I called them and they said the increase was because they "recalculated my information and saw an adjustment was needed." I demanded they cancel my plan, as I had not agreed to this premium. They said I wasn't allowed to cancel until the next open enrollment period with my employer in December 2025. They said they would open an appeal on my behalf and created a ticket, but I’m doubtful it’s going to make a difference, they will likely just reiterate what they already said and not allow me any recourse. Are they allowed to do this? Do I have any options in this situation or do I just have to accept that they can charge me whatever they like throughout the course of the year? I was not aware rates could change mid-policy like this. I am 48 and healthy. I have a nearly $10,000 deductible, and don’t go to the doctor for anything outside of my yearly checkup because I cannot afford to pay for anything out of pocket. I’ve also stopped taking prescribed medication because I don’t want to pay for that out of pocket either, and I can get by without it. It’s crazy to me they’re allowed to do this. Apologies in advance if I have posted in the wrong place.

So like the title says I had 2 doctor visit back to back days. One I saw the PA and the other I saw the NP. But the medical claim with my insurance says I saw the doctor. I received a bill from the clinic stating I owe an additional $76.93 for the PA and nothing additional for the NP. Both doctors are from same clinic but different specialties. I reached out to my insurance and they said it was both bill coded as me seeing the doctors. Is this correct? I reached out to the billing department of the clinic and it’s been almost 2 weeks and they haven’t gotten back to me yet. Is this correct? I paid $220.63 both times (I have a high deductible plan) I think. I don’t have a copay - I pay for everything my insurance doesn’t cover(which they don’t cover very much) If you have more questions to help answer this let me know. In the last month I’ve spent $1600 in medical and I want to make sure I’m being billed a surplus amount. Edit- I’m 29F from Texas and I’m insured through my job with UHC