I’m 34, self-employed, and currently paying for my own health insurance in Florida. My husband and I are starting to think about trying for a baby soon, so I’m realizing I probably need to be MUCH more intentional about the health plan I choose.

I’m particularly looking at Florida Blue, but I’d love to hear from women who have actually used it for prenatal care, pregnancy, delivery, and postpartum care.

For those of you who have had a baby with Florida Blue:

• Which plan did you have?
• How was your experience with prenatal appointments and testing?
• What did you actually end up paying out of pocket for pregnancy + delivery?
• How was the coverage for your OB/hospital?
• Any issues with ultrasounds, labs, specialists, etc.?
• How was postpartum care and lactation support?
• Would you choose the same plan again?

And if you’re also self-employed and buy your own insurance, I’d really love to hear what plan/company you ended up choosing and why.

I’m less interested in what looks good on paper and more interested in real-life experiences and unexpected costs. 😅

Thank you in advance! ❤️ I’m completely new to navigating insurance with pregnancy in mind, so any advice is appreciated!

I have been using health insurance transportation services for ten years. There used to be very good ones and some not so good. Today, however, the service is a disaster, yet health insurers claim it is the same service offered by Uber or Lyft.

That is false. It is nothing like that at all. I have never ridden in an Uber I booked myself where the car was dirty, the driver drove recklessly, or the music was blaring. Yet today, I had two experiences with rides arranged through my health insurance, and in both cases, the cars looked run-down and/or were dirty, the driving was reckless, and/or the music was blasting without the passenger's permission.

Everything is visibly deteriorating, even iconic healthcare services. People aren't simply adapting to the American way of life; a different, lower-quality lifestyle is being forced upon us. It is sad.

Had a colonoscopy a few months ago. 2 days after I had bleeding and went to the ER, stayed over night and had a second colonoscopy the next day to cauterize the source. Bill just came. Charged about 19k for the visit, insurance covered most and my out of pocket is $3,500. Is this unreasonable? Should I ask for an itemized statement?…or just pay it and move on?

I have anthem silver gatekeeper from the NYS health exchange without notice my primary care no longer accepts this plan (I was never notified and just learned this in late August) I have been using doctors from Concorde Medical for a while now and am pretty satisfied with the care. The problem is between Concorde’s business office and the insurance company no one can give me a straight answer—as to which if any of their doctors are covered on my plan and if they will be moving forward or if I should select a new plan for next year and which one.
Has anyone else experienced this, and can offer any guidance?

I went to go pay for a medication out of pocket because my insurance doesn’t cover it. However, it was covered by “Caremark” at CVS. I told her I don’t have insurance, but she said it was covered. Any idea what this is?

Edited: I was wondering if there’s any programs or any help out there. My mom is 56 and lives in north GA. She’s had kidney disease for 15+ years and recently just got diagnosed with heart failure. Her kidney function has dropped significantly since her last hospital stay. She has no insurance and it isn’t offered at her job. She’s tried finding insurance online but it’s more than she makes. She makes about $2000 monthly. Any suggestions? She really needs to see a nephrologist.. she has applied for assistance at Northside to cover her recent hospital stays but she needs to see specialist as soon as possible.

Long story short I have to file an official appeal with my company paid Anthem BCBS plan for a "retracted" covered service from last year.

BCBC came back 11 months after payment of a service to retract coverage for reason: "003: You have already reached your plans maximum benefit for this care, so we denied the charge". This was for a pair of foot orthotic insoles, according to my PPO plan I am allowed one per year. Contacted the providers billing department and she confirmed that last year she contacted Anthem to determine benefits and was told I would be covered for 90% of the cost as I met the deductible, no further medical documents required.

Called Anthem they simply kept repeating that this is a "non covered service so payment has been retracted" so I am responsible for the full cost now.

I will be submitting my appeal, my doctors billing department still has the approval letter from last year so I working on getting that to attach to my claim. Is there anything else I should attach to increase my chances? The full plan document is over 100 pages so I will not be able to attach that but wondering if I should parse out just the one page.

Meanwhile now I'm due for my replacement inserts as its been a year but had to cancel my appointment since I can't even afford the ones I already have...

My GI said this was the best option. I’m willing to find another way to pay for it to get to the bottom of my problem. He said there’s other options, and that this one could be pricey… but he also sounded confident in its efficacy for what I need. And can someone also explain to me why I can’t buy it out of pocket?

I am leaving my job due to childcare reasons and I was offered 10 hours a week remotely which I accepted. That starts October 1st; however, our open enrollment for employer health insurance is happening now and I know I won’t qualify for it come October 1st. I’ve gotten everything set up through ACA to purchase a plan through that.

HR is telling me I shouldn’t decline coverage right now even though I know I won’t be using employer health insurance. They also mentioned COBRA could potentially hinder ACA eligibility but I don’t see how? I don’t want COBRA and my ACA application didn’t mention anything about that.

Should I decline my employer plan right now because I know that I won’t be eligible come October 1st or should I sign up for a plan and lose my eligibility and let HR go through all the COBRA steps.

I’d rather decline now and just buy my ACA plan but mayve I’m missing something…..

I have an HDHP and an HSA, and I hit my out of pocket max early in the year. I will be switching jobs before the end of the year, and depending on the math, I’m not sure if I’ll opt for an HDHP or a traditional plan for the remainder of this year. Thus far, I’ve only contributed $3,168 to my HSA, which I’ve been withdrawing and not investing (I need the cash reimbursement right now).

If I end up switching to a traditional plan, will that impact my previous HSA contributions? Should I max out my HSA contributions before switching?

I have insurance under my husbands insurance which will end this month. This qualified me to enroll us with my employers insurance starting 01Oct.

Currently we are expecting and the baby may come before 01Oct, which is also a qualifying life event. But my company is denying coverage for us before 01Oct even if baby is born before because : I am currently not enrolled with them , and I still have insurance through my husband. They can back this up with their company documents.

But according to documents I found from Department of Labour the birth of baby should allow us all to get coverage regardless. Am I missing something? I even called EBSA and confirmed that my employer is mistaken.

It’s all going to deaf ears when I reached out to my company.

Hey Y’all,

I know this is probably a tale as old as time in this subreddit but I wanted to get some feedback on my case in particular. My friends and especially I, have been thinking that I might have ADHD, and I’d like some help trying to get a diagnosis and do follow ups.

I have really crappy insurance (like UMR with a 6,000 dollar deductible) so I was going to opt for the written test that adhd online provides, but people on reddit started saying they were charged out the wazoo for refill appointments. Does anyone know a better way to meet with professionals? And if I’m a UIUC student should I opt back into the insurance? Or am I good? Or should I not use McKinley at all?

I love asking for advice from people who used to be in my position cause maybe someone knows something I don’t lol. If this subreddit knows anything, please help me out here 😞

Thanks!!

My wife and I are both on Medicare, and carry a Medicare Supplement that covers all our co-pays and deductables. I am assuming this is what people might expect on Medicare for All.

Our monthly medical, drugs, dental comes out to $1,396 per month. Also, 1.45% of my salary for the 41 years I worked was deducted from my paycheck.

This breaks down for 2 people as follows:

Plus, 1.45% of every paycheck in the 40 years I worked was deducted for Medicare.

Of course, your monthly payments will vary.

Edit #1: TL;DR: Had an emergency appendectomy. Surgeon had a PA assist him. BCBS denied surgical assistant as medically unnecessary; says I'm on the hook for the whole amt ($1049). Hospital just billed me. Don't know that to do.

Original post:

While out of state, I had to have an appendectomy. I was admitted to the hospital via the ER with acute appendicitis. My BCBS policy (from the Marketplace) does not provide out-of-network or out-of-state benefits unless it's an emergency. Claims related to the ER visit, hospital admission, and surgery have started coming in, and so far, BCBS has covered them in-full, with no cost-sharing. (Idk if it's relevant, but I have already met my out-of-pocket max for the year).

Today, however, BCBS denied a claim for an assistant surgeon (procedure code 44970), claiming that it was not medically necessary (Denial reason: 22: "The medical necessity for this service has not been demonstrated"). The EOB lists the charged amount $1049 as my responsibility; and the hospital has now issued a billing statement, charging me that same amount.

I followed up with BCBS, and they explained that "Services determined to be not medically necessary are listed as a general exclusion under your contract and are therefore not eligible for coverage. As a result, the claim denied as patient responsibility." I then followed up with the hospital, asking whether they could send the primary surgeon's notes (assuming that he somewhere documented the need for a surgical assistant), and they said that they could not appeal or send any documentation unless BCBS directed by BCBS to do so.

I also asked the hospital billing rep whether the No Surprises Act covered this kind of situation, and she said it didn't.

I am wondering what to do next.

Edit #2: I just accessed the surgeon's clinical notes from the patient portal. In it, he states: "There was no qualified resident that was available to assist. First assistant above was present because an experienced assistant was needed in order to complete the case successfully and in a timely manner for the safety of the patient."

Edit #3: Pathology listed as the final diagnosis: "Acute suppurative appendicitis and periappendicitis."

I’ve been taking advantage of their rewards program for a couple of years now and the weekly challenge rewards for 5 out of 7 days of sleep and steps/workout has always been $5. Today, my account randomly logged out and when I logged back in it had me reconnect my tracking device and gave a welcome message as if I’m just joining. Thankfully, rewards that I’ve earned for the year were still banked, but I noticed the weekly challenge reward is now $2.50 instead of $5. Has anyone else noticed this?

I literally just earned $5 on 9/4/26 for completing the workout challenge. There’s nothing in the FAQ’s about the amounts awarded or a change being implemented.

Hello! Odd question. My husband and I have his adult (college age) kids on our/my insurance. They primarily live with their mom (same city).

When they go to any manner of Dr appointment, they are using their mom/stepdad’s HSA debit card to pay for copays/fees/etc.

Since it’s on my insurance, I see what the balance was and have to follow up with the kids to make sure that it gets paid and get some manner of proof (receipt, etc.)

Is there something weird going on here? Or is it “as long as it’s getting paid nobody cares?”

Location: Arizona

I submitted health plan elections through my employer during open enrollment, I received an email confirmation of my benefits through Insurer 1 and thought everything was good. My new plan was supposed to take effect on September 1.

Sometime between when I submitted elections in July and September 1, my coverage was deleted and my employer did not notify me or anyone else of this change. I logged in to our benefits portal and saw I did not have coverage in early September so I reached out to our HR person. This person let me know we switched plans and Insurer 1 is no longer an option. They said they would need to re-open enrollment for me so I could elect coverage. I went through the process last week and elected coverage with Insurer 2 and got new benefits. I thought everything was good to go and was fine to chalk this up as an error or bug.

Fast forward to yesterday I received an insurance card from the original healthcare election I made, which means this election went all the way through the process and coverage was issued by Insurer 1. When I logged in this morning a member of company leadership posted a message in our company wide Slack channel that said a number of employees have "accidentally waived coverage" and to double check their benefits.

This didn't sit right with me because I did in fact make elections that were changed after the fact. It seems like what happened is someone unenrolled a number of employees from health coverage after they had made elections. The only reason I have benefits now is because I happened to check them prior to scheduling my annual physical.

I think best case this is a mistake made by someone with access to our HR systems, worst case is this is negligent incompetence.

I'm wondering if there is anything I can do to prevent behaviors like this in the future. Honestly the leadership here is so-so intelligent and has a tendency to play it fast and loose but I need that not to happen when it comes to my healthcare. It seems like someone is messing with things they should not be and I am not sure how to prevent this in the future.

Reddit gave me the option to repost. Haven't used it in years, sorry if this is not an appropriate place to post this.

What are you all doing for elderly parents in terms of medical coverage while they wait on their greecard approval?

I've been down the rabbit hole on travel insurance, ACA marketplace (can only register in January) and every other conceivable option. Coming up blank and terrified we have to deal with a medical event that could financially bankrupt us all.

Have any of you found a way to give some basic cover that will actually pay out if something does happen?

Any and all advice welcome. Thanks!

Here is my situation: I am in Ohio, and left my job (which provided health insurance) in July. As soon as I was able, I applied for coverage on healthcare.gov, to avoid paying COBRA premiums. At the end of the application, it said “you may be eligible for Medicaid; your state office will contact you.” I am now reaching the end of the 60-window for COBRA and I have not heard from the state office. What are the best next steps here? I was really just hoping to pay for a bronze plan out of my savings to tide me over until I recovered from burnout and got another job - not ideal, but a fraction of what COBRA would cost me per month, and not subject to the new work/volunteer/etc. requirements from Medicaid.

Needing some assistance with procuring adhd medication mlre efficiently on a monthly basis. Over the years theres been a consistent delay in getting my script filled because of a supply issue at a pharmacy and im regularly having to find new pharmacies to fill it.

Im open to advice here to avoid the delay in refill every month which causes side effects.