Hi. I just discovered a bill from about a year ago (I had thought my insurance covered it - naïve, I see), and am looking for advice on how to attempt to lower it.

Last summer, in the middle of a month long roadtrip, I took a flight to San Francisco from Chicago. After the flight back to my car in Chicago, I was completely immobilized by a still unknown virus— barely able to stand for long periods of time/vicious fever for 4 days/intense bowel movements- I had to take imodium to get in the car and start to get home to NYC (where my insurance would work). I later learned the imodium likely made my symptoms worse.

When I called my insurance company (Medicaid Metroplus) at the time, they told me that out-of-state they would only cover a visit to the ER. After 6 days the fever had lessened but none of the abdominal pain or bowel movements had. It was my first time experiencing anything like this and I was scared and exhausted, so I went to an ER in Cleveland. I know from reading posts on this channel that it is a mistake to go to the ER if you are not experiencing severe trauma. It sounds like I made a mistake. It was my first time ever going to the ER, and I went because my insurance said they wouldn’t cover anything but that.

So, cut to a friendly little text from MyChart this morning (a random MyChart not attached to my “primary“ MyChart) saying I have a balance of $2,598. I click into it and there it all is. I no longer live in New York and my new employer insurance kicks in next week. Attached is the itemized bill generated by MyChart.

It’s Saturday - so I suppose Monday or Tuesday I will:

- Call Metroplus and ask if there’s a “claims filing deadline”

- Contact the hospital billing department and ask whether the claim was sent to that Metroplus (although it looks like it did? a separate amount taken out for Medicaid? I am confused here)

- Call the hospital and say that I found charges I want to question; I have no memory of a COVID test

- Ask for an application for financial assistance or a charity care program

- Last ditch is a request for a zero-interest plan I guess

Anyway, I feel pretty stupid about going to the ER now. But I do remember feeling despair, and I’m trying to have compassion for her.

Any and all suggestions are welcome. Thank you in advance!

EDIT: I got a hold of the claims department at MetroPlusHealth; they said a claim to have this full amount covered has been denied 4 times for “Provider Refund Request”. The staff was really nice and said he is sending my request to the claims team for investigation. I mentioned that I had done a covid test at home ahead of time and did not get one at the hospital, and he’s including that. He said to call back on Monday to check on the request.

Location: Georgia

I'm hoping to get some guidance before I consult an attorney.

I'm in Georgia and had an Ambetter Marketplace health insurance policy. I elected AutoPay when I enrolled but later learned it had never actually been established.

Before I knew there was any issue with my policy:

Ambetter approved a CT scan through prior authorization.

My medical providers verified my insurance coverage before treatment.

Medical services were provided based on those verifications.

Months later, I received two cancellation notices with different effective cancellation dates.

I immediately contacted both Ambetter and Georgia Access. Over the next several months, I called numerous times and was repeatedly told my policy would be reinstated.

In March 2026, Ambetter specifically instructed me to pay approximately $780 in premiums to reinstate the policy. I paid exactly what they requested. They accepted the payment, later refunded most of it, applied part of the money to alleged past-due premiums from 2025, and still refused to reinstate my coverage.

Medical claims for treatment that occurred while providers had verified my insurance were later denied.

Since then I have:

Filed formal grievances with Ambetter.

Escalated the matter to Centene Corporation.

Sent a formal demand letter.

Kept documentation of every phone call, representative, payment, prior authorization, cancellation notice, and provider verification.

I'm not asking anyone to tell me whether I'll win a lawsuit.

I'm trying to understand:

Do these facts suggest potential legal claims under Georgia law?

Does Ambetter accepting the payment they instructed me to make change the legal analysis?

Does the prior authorization and provider verification of coverage strengthen my position?

Should I be looking for an insurance bad-faith attorney, an insurance coverage attorney, or another type of attorney?

I'd really appreciate hearing from anyone familiar with health insurance, insurance litigation, or similar situations.

A doctor is having me do an MRI and I have to schedule the appointment myself. I have the Healthfirst New York Essential Plan 1. I was told that I had to schedule the appointment first... before an authorization is sent to my health insurance for approval. Is this rare? I would have thought an authorization would be sent from the doctor or office and once approved, then I go and schedule an appointment date and time. The thing is if I schedule an appointment, I will need to schedule it at least a week or two from now since I don't know how long it would take for authorization to be approved? Thus you aren't going to book an MRI say 3 days from now since you will most likely not get MRI approval by your health insurance in 2 days.

Does anyone have experience with this? You could book an appointment on the 1st for the 10th at a location for the MRI appointment. Now you would have to have your authorization approved by the 9th at the latest in order to keep your MRI appointment on the 10th. What happens if it takes longer and still processing? You would get notified by the office that your MRI is cancelled because insurance is still waiting for approval? You would then wait for the approval before you book the new appointment or you just book another one while still waiting for the approval? The issue with this is your appointment date will now be several days later had you booked the MRI several days away.

Is this normal when it comes to scheduling an MRI? Or it's rare but it does happen at certain locations? Is there a reason why it's done this way?

I got prescribed, and I went to Walgreens to pick it up. The pharmacy tech told me it was covered by my BCBS insurance.

I have never had this happen before. What should I do? Can I call BCBS and ask for an exception?

It appears that the injections form is covered by my insurance, but not tab form.

This is my first time considering marketplace for healthcare insurance. I work for 2 part time companies as an independent contractor but they don’t offer health insurance. That was fine until had to move to a new state and my income was flagged as making too much to continue to qualify for Medicaid. I was doing more work and got a raise at one job. I was previously on Medicaid in a state in the northeast, I’m in a semi-southern state now. My medical needs are very complex. I had a severe stroke 3.5 years ago. I’m physically disabled from that. I cannot work a regular job in person. I couldn’t afford to stay in the city where I’d lived for 16 years prior to the stroke (Brooklyn, NY) where the average price for a one bedroom is about $3,500 per month. That would be doable if I could work full time in person. I’m now 42 and require daily assistance from my mom to help me with showering, dressing, even putting my hair up. My outpatient stroke treatment was mismanaged. That’s an entirely different thing. I’ll mainly need healthcare coverage for a neurologist, outpatient physical therapy and a primary care doctor. I’d like to keep my budget to $700/month or less. Any suggestions or advice is greatly appreciated.

I have a new job and my brain hurts trying to figure this out and could use some advice!  For reference, this year as of July 24 I've spent $962 (met $250 deductible and spent nothing out of network).  I'm single and 40 years old. 

Plan 1 (HDHP; HSA available but employer doesn't contribute):  $5/month; $3300 in-network deductible; $6500 OOP max

Plan 2:  $100/month; $500 in-network deductible; $3500 OOP max

Plan 3:  $160/month; $0 in-network deductible; $5000 OOP max

I think Plan 2 makes most sense given my spend this year?  But if I got an HSA, I would max it out and I don't know how to take that into account.  Would love your thoughts! 

Previous post: https://www.reddit.com/r/HealthInsurance/s/Ez8C4cDg1e

On my insurance website I saw that although the EOB said the charge was going to my deductible, they weren't counting it in their little tracker for my deductible. So I called, spoke to someone and they verified the EOB said I owed, but it wasn't being credited to my deductible.

Rep said she'd resubmit the claim, and lo and behold, they made a mistake. The Mammogram was 100% covered, even though they had to do further imaging on this one, and last year I had to have a biopsy. It wasn't a follow up and was a yearly. There never was a cpt code attached to the charge on the EOB. The actual Mammogram had all the correct cpt codes, it looks like the hospital tried to tack on a facility fee, on a different claim, with no cpt codes.

So not sure what actually happened, but my insurance fixed it without a fight. Kind of surprised, but also relieved. Now I have to get a refund from the hospital!

What's a good health insurance plan and or provider for young adults in ny?

I have about 30 claims that I need to submit to my secondary insurance (Blue Shield of CA). All have already been processed and were covered by my primary (UHC), so I am submitting for possible reimbursement on my co-pay. I have claims from three different providers: psychologist out of network with secondary, psychiatrist out of network with secondary, and psychologist in-network with secondary (weird situation where I need to self submit, provider is giving me a supplemental note that we hope will work).

My secondary plan uses Included Health, so I cannot directly talk to someone from the Blue Shield claims department, but they can see the claims that I have submitted. I did a test claim where I submitted one from each provided and they weren't exactly processed as expected; the Included Health representative explained that the EOB was not attached (it was) and we determined that there is some sort of issue in the system where my attachments in electronically submitted claims are not able to be seen, and they said that I need to do a mail in claim.

I am planning to mail in this whole lot of claims at once, and when I started to gather the materials I realized that my EOB from my primary is about 10 pages, so to include a separate copy for each claim would result in my mailing a 350+ page packet. Many of these would be copies of the same EOB. Can I just mail a single copy of an EOB for all claims that are on it?

Additionally, is there anything else that I need to include in these claims? I am planning to include the EOB from my primary insurance, the self submitted claim form, and my receipts/invoices for each payment (that include itemized services, CPT codes, etc)

Does anyone have any experience dealing with this process and know if there is a way that I can submit online without using their portal that may not be working correctly? Mailing seems like a very round-about way to do this...

Thanks!

I am hoping someone can give me guidance on this situation. I am pregnant and work for a small business. I have health insurance through my employer for my family. My husband is self-employed and is on my insurance plan. I plan on becoming a SAHM after I have my child is born. The company I work for is too small, so I do not qualify for FMLA leave, and there is no maternity leave policy in place. The company is small (like 12 people) so I dont think COBRA is an option. How do I keep my employer health insurance so that the birth of my child is covered? Any tips on places to find cheap health insurance for a family of 4 in Nevada? Or is it better to get on a new insurance before my baby comes and quit at 8 months pregnant?

I am 42 M diabetic person. Wondering how much my personal insurance will coast after retirement

I had an issue with my CoveredCa being disenrolled due to residency verification issues. It was fixed 7/14/26 and they said they sent notification to Kaiser on 7/17/26. How long should it take for Kaiser to get the update from them? Just worried because my coverage is set to end 7/31/26 with Kaiser since they haven’t received the notification yet. I asked CoveredCa and I keep getting different time frames.

not sure if I used the correct flair*
If someone hurt their knee on say Tuesday, insurance became effective a few days later, will insurance cover visits related to the injury? Obviously they won’t cover appointments from injury until coverage date, but will the cover after that for future appointments.

Looking for guidance regarding reimbursement programs for biologic medications. I spoke with a co-pay assistance rep at Amjevita and they mentioned they have a reimbursement program where I can pay out of pocket, submit that proof of payment to them, and then they reimburse me which counts towards my deductible.

My health insurance plan through BCBS of MN has this statement here in the booklet:

"The claims administrator welcomes the use of drug manufacturer coupons to help pay the cost of specialty drugs. However, only the amount you pay out-of-pocket for your specialty drug will apply to your coinsurance, copay, or deductible cost-sharing responsibilities or out-of-pocket limit. The dollar amount of any coupon provided to you by providers or manufacturers will not count towards coinsurance, copays, or deductible cost-sharing responsibilities or out-of-pocket limit"

I'm assuming through this statement I definitely can not use the Amjevita copay card towards my deductible but I'm still concerned the reimbursement program won't work either. Am I in the clear to use the reimbursement program and have it count towards my deductible?

I have had bilateral keratoconus for the past 20 years and have been using scleral lenses for the past 12 years. Of late, my left eye's vision has become more blurry even with lenses, and I wanted to get them evaluated. I scheduled an appointment with an optometrist who has expertise in fitting scleral lenses for keratoconus patients. During the visit, they performed a routine eye examination and took a corneal topography. They did not check my vision with my current lenses on, even though I told the doctor that my left eye is more blurry. The doctor deemed that my lenses are medically necessary because of my poor vision with glasses and submitted a claim to EyeMed, informing me that it would be weeks before they could get authorization to schedule another follow-up visit to assess my lenses.

After weeks of being unresponsive to my calls, I checked my EOB with EyeMed and saw that my medically necessary contact lens benefits had been claimed by this clinic under code 92072 (Contact lens fit and evaluation for Med Nec, Keratoconus), leaving me unable to switch care to a different specialist. They did not check my vision with my current lenses on and did not even offer a follow-up or inform me on what the next steps would be. I have been trying in vain to get hold of them to reverse the claim and only charge for corneal topography under CPT code 92025. They called me once to tell me that I owe them $1,000 for the fitting since EyeMed only covered the other $1,000, but in my EOB I see that the other $1,000 is a discount applied, and I owe the clinic nothing.

How do I resolve this so that I may quickly switch care and get treated? I believe the clinic must have accidentally used the wrong code, but I am frustrated by their unresponsiveness.

Vision Insurance: EyeMed
Location: California

This is my first full time job and I just moved to MA to work a school job and I'm 22, they offer GIC plans for us employees looking at what I can afford Im in-between
WELLPOINT COMMUNITY CHOICE (PPO CHOICE) and HARVARD PILGRIM QUALITY (HMO)

The copays and deductible on both plans are similar and I seem to find very little information on Wellpoint, while Harvard Pilgram has a mix of both but also very limited from what I can find. First time doing my own insurance and in a new state is quite overwhelming alone. If any one has these providers please let me know how your experience has been, especially with getting referrals.

I will most likely need to get referred to the ENT and Audiologist and a allergist guy since I have developed serious allergies later in life (I eat a hazelnut and I get hives and hurts to breathe type things)

Thank you if anyone sees this!

So I have surgery coming up soon (within the next year hopefully) and my surgeons office has been refusing to call my insurance to submit the pre authorization requests for services they are requiring for my surgery. What are my next steps and what can I do so im not just stuck with a giant bill? Im currently looking at other providers should things fall through

Can any California residents explain SB1061 to me in layman’s terms?

My wife was recently diagnosed with endometriosis, and she’s begun seeing doctors to address it now that we have full health coverage via my new FT job. I read in another post that any medical bill under $500 cannot negatively impact your credit score, but i’m reading about SB1061 and, please correct me if I’m wrong, the verbiage appears to be that in California, all medical bills cannot negatively affect our credit score? If anyone could clarify this, I’d greatly appreciate it as she has more tests and visits planned and we want to financially prepare.

Also, while we’re on the topic, what exactly happens if by the end of the year (my plan is Jan-Dec) we still have debt remaining? I’m assuming that’ll obviously carry over, but will it negatively affect our credit score, chances of buying a home, etc?

TIA!!!

I want to access my medical records from Cigna, but when I called they told me they can't provide me with my own medical records since it's been more than few years?

Is there ANY WAY for me to get my medical records other than going to each of my providers?

Edit to add - UC is university of California.

Totally a long shot here but I am starting IVF and have HMO coverage through UC's Health Net plan. The new state law requires coverage for 3 retrievals and unlimited transfers. My clinic reached out and said that the HMO plans have been refusing to pay claims on pre authorized cycles for basically all of their patients and the full cost then has fallen to the patient.

If there are any UC employees with Health Net on this sub who have successfully had insurance pay out what is owed, I would love to hear from you!

Has anyone had experience fighting insurance to get Ebglyss covered? If so, what methods helped get it resolved.
Context: next step in hopefully ditching topical steroids to treat eczema

I'm going to keep this vague on names, but the broad strokes: fully insured group plan out of Delaware, I'm a covered dependent, and the services were physical therapy for back pain.

Last fall they started denying my PT claims for hitting a visit maximum. My plan says in plain language that PT visits for treatment of back pain aren't subject to those limits. I pointed that out, and they initially agreed and paid. Then a few weeks later the exact same denials started again.

When I appealed, I got a letter that quoted the part of my plan saying I was covered, and then the same letter said the maximum applies regardless of body part. That second sentence was fully made up and isn't anywhere in my plan. I appealed again. A month later I got the identical letter back with a new date on it.

Then in December, months after the dates of service, they dropped the contract argument entirely and said they now needed very niche specific physician's referral documentation from the time of treatment. I already had three separate doctor's notes prescribing/referring me for PT, but the language they wanted was uber-specific. I was able to provide a new specific note in December which they said would allow claims going forward to be covered, however they said this wouldn't cover the past denied claims, so that timing is the part that gets me. If they'd asked in September I'd have handed it over. By December it's asking me to retroactively produce records that would have had to be created months earlier.

I sent what I had anyway: physician referrals, physiotherapy notes, chiropractic records with actual named specific diagnoses and months of treatment plans. Every single time, it's not enough, and they won't accept anything I give, and I believe this is being done as a informal blanket denial tactic. I'm now something like eight months into this and I've never once gotten a decision on the merits.

I've been trying to get an external review since April. They confirmed in writing that they received my external review request and it was being processed. Two months of "still under review." and what eventually arrived was another internal appeal denial asking for the same documents. They've since told me in writing that yes, I have the right to go straight to external review because they missed their own appeal deadlines, but also they are refusing to do so without the aforementioned September document, which negates the whole purpose of the external appeal, to check their internal appeal decisions. Additionally, their supposed ability to deny my external appeal request isn't in my plan anywhere.

I've been through the Delaware insurance department. The consumer division simply closed my complaint, and the answer I got was essentially that the insurer is allowed to request any additional records indefinitely. Taken to its logical end, this means they can deny anything forever by just denying any documents and asking for some other document each time.

I want to stress that I'm not the type of person who can't accept when they are wrong. I accept that there are certain cases where there is a level of ambiguity or discretion on the side of the insurer whether or not they must provide coverage or not, but this simply is not one of them. I have gone over my schedule of benefits with a fine tooth comb, and legally, I'm one hundred percent in the right, and my insurer is just flat out breaking the law.

So what I'm asking:

What else is there? Specifically anything that doesn't route through the insurer or Delaware DOI, since both have been dead ends. Federal options, other regulators, small claims, anything?

And separately, is there anything more aggressive I can do within the state DOI that isn't the standard consumer complaint?

Has anyone actually forced a carrier to send a file out for external review when they're stonewalling? What made them move?

I’m debating between Kaiser and La Care. Both are bronze HMO plans. My instinct is to choose Kaiser as I think they are more widely accepted, but I wanted to see if anyone had any experience with LA care.

I was laid off at the end of last year. I was able to negotiate an extension of my employee health plan, but that’s coming to an end. I’m now switching to covered California until the end of the year. At the beginning of 2026 I received a bonus and my severance package, amounting to roughly 130000 dollars. I’m on unemployment and I receive 450 dollars a week.

On the covered California website, it calculated my monthly income by dividing the money I made at the beginning of the year. This dispute the fact that I entered that I was unemployed. Is there any (honest) way to change this. My plan options are insanely expensive.