I have Aetna with acupuncture coverage. I had seen a provider 6 times, 3 times in 2023 and 3 times in 2024. All of the visits were coded CPT Code 97811 and CPT Code 97810. In 2024, I saw the provider in January, June, and July. For some reason, the visit in June was denied and Aetna said it was experimental. But the provider billed using the exact same code as before and after June 2024. All other claims had been paid. I'm at a stage of appealing this decision. But I'm wondering if anyone has any insights into why a claim would randomly be deemed experimental when it was paid as normal otherwise?

Has anyone had any luck getting Emblem HIP to cover prescription formula (Nutramigen) due to a baby’s milk allergy? Emblem is of course giving me the runaround

Not sure if I tagged this right, but basically I was covered by a MA ConnectorCare (CC) plan until January 31st of this year, and now I am covered by my employer's BCBS plan as of February 1st. I received my first Gardasil shot on January 31st, the last day my CC plan was active, but my doctor billed BCBS (I added it for my second shot on Feb 28th) and now I'm getting a $700 bill for the office visit and the shot because that coverage wasn't active yet. Is it possible to tell their billing department they need to retroactively bill the CC plan as that's what I was covered by on the date of service? I actually work at the office where I got my shots, and I have a pretty good idea of what my plan will cover with or without a copay, and this is not correct.

I have BCBS Horizon of NJ PPO. It’s my dad’s plan thru his work at a large sales company that has no religious affiliation. He’s worked there only a few years definitely after 2019. His job is in NC, I’m a MD resident. Currently battling insurance for a bilateral salpingectomy which is a form of permanent contraceptive and falls under preventive care and the ACA. My plan offers preventive care 100% covered in network. My insurance is telling me it’s covered at 80% after my deductible is met ($1200). One rep even told me my plan must not be aca compliant then. I looked into that and BCBS NJ horizon has not offered a non aca compliant plan since 2013. This rep is flat out lying, right? Well she gets a supervisor involved and he can’t confidently say whether my plan is aca compliant or not. It covers birth control 100% (I currently am on a 100% covered by them birth control). I think they may be looking it up as an outpatient surgery and not as preventative care. How do I tell them to look at it from preventative care and not outpatient surgery? Is it even possible for my plan to not be aca compliant? I’m currently in communication with an hr person from my dad’s company. She hasn’t gotten back to me yet and I really want to sleep tonight. My surgery is March 27th and I really can’t afford for it to not be 100% covered. Please help 🙏 💜

I had gone to a new dentist in October 2024 for a routine cleaning and was essentially "upsold" on the removal of my four wisdom teeth, as I had mentioned they were bothering me. I was told my insurance was accepted (MetLife) and that I would only pay $300 for the removal. I figured that was a great deal and had my teeth removed, paying the $300 on my way out. I received an email earlier today for a separate claim from Cigna, and decided to look at my MetLife portal as I remembered the dental claim being stuck on "pending" for some time after the procedure. According to MetLife, the cleaning and x-rays were in-network and 100% covered, but for the wisdom teeth removal, the claim was marked as out of network and my patient responsibility is $800. It has been a bit over 4 months since the procedure and I haven't received a bill from the provider - should I just leave things as they are or should I contact my insurance provider/dentist? I only accepted the procedure because of how affordable it was and confirmed with my dentist multiple times that $300 was my total cost for all 4 teeth after insurance.

Last June, I went to urgent care because I was leaving for a vacation out of the country the next day and started feeling sick. I couldn’t get into my primary doctor before leaving and just wanted a steroid shot or antibiotics to avoid being miserable during my trip. I went to an urgent care near my job, knowing it would be more expensive than my normal copay. I usually pay a $25 copay at my primary doctor, but urgent care costs $50. When I arrived and checked in, the receptionist asked for my insurance cards, which I provided. I’m double insured, as I’m still on my parents' insurance, but I use my insurance as primary and my parents’ as secondary. I’ve never had any issues with this setup and typically don’t have medical bills because of it. The receptionist asked if another name (I assumed it was another patient) was on my insurance policy. I confirmed that I’m the only one on my insurance policy and explained that my parents’ insurance is secondary. Both of my insurances are Blue Cross Blue Shield, though I’m not sure if that matters. The receptionist seemed confused but said, "Okay, it’s going to be expensive, but your copay is $50." I agreed, since I felt awful, and paid with my HSA card. I was only tested for strep and flu (both negative) and was diagnosed with a sinus infection, for which I received a steroid shot. Fast forward to my trip abroad, where I had to visit a doctor at my resort, pay $500, and was diagnosed with bronchitis and the flu. Last week, I received a call from a collections service saying I owed $244 for my urgent care visit. I asked how that could be possible since I was double insured, but they couldn’t answer. I called the urgent care, and they directed me to their billing number. After waiting for an hour and a half on hold, I was told I owed the amount. I asked again why, given my double insurance, and they said they only had my parents' insurance on file, and that their insurance had denied the claim. I asked why it was denied, explaining that my primary insurance at the time was through my job and my parents’ was secondary. They asked to put me on hold to investigate, but the call was dropped. I called back and was on hold for 45 minutes. I then received a call from an unfamiliar number, and the voicemail said the call had been disconnected and to call back to resolve the issue. I called back and reached a different urgent care I’d never heard of. I asked for the person who left the voicemail, and they said they didn’t know anyone by that name. I explained the situation, and the person said they had been receiving similar calls from others and advised me to be careful with the information I shared, as they were unsure if their office number had been linked with spam. I then went to the original urgent care, which is 10 minutes from my job, and asked for clarification. They explained that my primary insurance was never added to my account, but when I went in for clarification, they added it to my file. Since their billing has been outsourced to a third-party company, they can no longer access statements or accept payments. They directed me to that number but said they would speak to their manager and call me back since they’ve received multiple complaints since moving to this company. I’m unsure what to do now, as the urgent care never billed my insurance correctly, and the bill has now gone to collections. Any advice on how to proceed?

I purchased private health insurance through an agent with Freedom Life Insurance. I'm starting my own business so have to handle my own insurance. I got a Freedom plan that is supposed to give me 4 free doctors visits before deductibles/copays kick in, and somehow I'm paying more than my insurance every time. They only pay $100 per visit. I am livid that I'm spending almost $400/month for a policy that doesn't seem to pay anything!! What is the deal with this?? They only pay $100, the rest is on me. This is directly different than what I was told it would be, and there's no way for me to know what I'm going to be paying unless I get a full bill breakdown from each doctor beforehand which I have never in my life had to do. The plan is a United plan, yet my agent said these major doctors don't have a good contracted rate with United. HOW? United is universally accepted. Should I have my agent find me a different plan? Go back to Marketplace where they switch your plan every year? Where the heck does a person go to get health insurance that isn't rocket science, actually covers what it says it will cover, and doesn't change all the time? Does the plan I'm on even sound normal?

Anyone currently enrolled in TBL please be aware they have changed how they are "insuring" retired first responders and their families. We have filed a complaint with the Ohio board of insurance. They have changed our plans without giving us the option of deciding if it's how we want to be covered. They have changed what medications will be covered and how our providers will be paid.

i went to urgent care to get HIV PEP pills. Which must be taken within 72 hours of a potential exposure. i payed my $10 copay and They prescribed me the medicine where I was able to get my medication at the pharmacy that was covered by Aetna. But when I checked they fully denied my visit when I called she said the visit was not urgent. i told her I want to do an appeal. But im Absolutely disgusted by Aetna im already traumatized. i feel this needs to reported but I don't know which agency I would need to reach out too.

Hi all, I'm running into a pretty frustrating issue. I have called like 50 clinics in the Austin area and even though they appear on the list of clinics that take my insurance, they don't. Is the only option to pay out of pocket? My son is 3 and has a delay that was diagnosed at 2. We had speech therapy for a while and he is doing a lot better, but I am having issues getting it covered. I have an Aetna plan that is self-funded through my employer. If I could find a clinic, they would cover the sessions at 100%. My son is 3 and I have called the school district, but they said it would be next school year before they could assess and set him up, if his delay is even serious enough. He does not have autism, he has no other markers for it besides the speech delay.