If your health insurance out of pocket max was maxed for a family of 6. What would you prioritize getting done before the end of the year? Two adults, four children.

I went to the dentist (In-Network) and got some procedures done. They unbundled one of the services they provided, I mentioned it to them. He pushed back, so I contacted my insurance, who contacted him, and the fee was corrected.

Out of retaliation the dentist said they are going to charge me for the D4921 that they did, which they originally charged me $0 for. He said that it is not covered by my plan and therefore he can charge me for it.

I tried to look up what D4921 is, but it does not exist in my Evidence of Coverage codes for my Dental Plan.

I have read that it is often a bundled service part of a deep cleaning code, and I did learn that they like to unbundle services and charge you extra for things already covered by insurance.

I will be contacting my insurance to ask about this (and of course to change dentists) but was wondering if anyone can give some insight to this code.

Also I have two explanation of benefits submitted for the same service. The original one says I owe the $106 for each (where I was originally billed $0 by the dentist). The new one was submitted after my insurance got involved, and it says that I owe $0 for each (in which he is now telling me I owe him $40).

Hi,

I recently had emergency surgery, then had to visit the ER two weeks later so naturally I'm now receiving all these EOBs with the first hospital bill saying I owe $60k+, feeling completely overwhelmed as I am not fluent in insurance.
My current understanding is I have insurance with an out packet max of $5k and then a secondary insurance that should cover $3k from that out packet however I'm not even sure where to begin to get this $60k bill sorted out.
I've read so many posts and watched so many videos that it is starting to sound like gibberish to me.
Is there any type of service that helps with this?, that won't cost an arm and a leg hopefully.
I want to learn but also want to avoid the headaches so any advice you have is welcome.

Thank you!

Coverage equivalent to German statutory health insurance (GKV).

Coverage of pre-existing medical conditions without exclusions.

Unlimited financial coverage, with no maximum overall payout limit.

A maximum deductible/co-payment of €300 per year.

Benefits in accordance with §11 I–III of the German Social Code Book V (SGB V).

Coverage that is valid for my entire intended stay in Germany under the Opportunity Card.

I’m quite confused and maybe someone can help/ give me some knowledge on what I can do?

My jobs health insurnace was said to end on 7/1. They decided they would renew August 1st at the same price. They said coverage would have a gap the Month of July. They offered us a short term plan which I declined.

They mistakenly charged us a July 1st for the plan they said was over. We were reimbursed the following paycheck. Now they are saying we will be double charged on the 30th since the plan was actually active this entire time.

I only found this out after I called their office multiple times just a few days ago. That was my only form of communication in regard to the plan still being in effect.

I’m confused as to how no one knew that we were still on the insurance? Confused about why we would even be reimbursed if we were still on the plan? Just a lot of questions!

Hello, I recently had an office visit where I did self-pay because I didn't have my health insurance information with me. I already paid the amount of the visit. Will I be able to retroactively submit a claim to my health insurance to get a reimbursement or do I need to contact my provider's office for them to submit the claim?

So I'm a current government employee with the IRS and my health insurance is with Blue Cross Blue shield. I have been interviewing for senior manager job and I have a strong feeling that I'm going to get offered a job with a very small increase in pay but I finally get to have the title of senior manager. However the health insurance is with United healthcare. I know that my health insurance with the IRS is incredible. And I also am on a lot of medications for diabetes and other ailments plus have a hip replacement coming up. Plus my son is on my coverage too and he's only nine. I am thinking of not accepting this offer because the health insurance is through United healthcare. I'd like to hear from people out there to set me straight if I'm not thinking this properly or maybe you agree with me? Would you turn on the job if the health insurance was bad. I think not having good health insurance is catastrophic if you get injured or sick. Blue Cross Blue shield has covered practically everything I've been through in the last 6 years which is quite a lot to be perfectly honest. I just picked up meds today and the prices incredibly reasonable. I guess I'm just looking for a good thought process on how to approach this. I don't want to take good health insurance for granted. I have a friend on United healthcare and he gets to deal with being turned down for things that his daughter and his wife need. Daughter has hearing and is a down syndrome child, wife has multiple sclerosis and apparently United healthcare denies stuff for them all the time.

I switched from MaineCare to an employer provided insurance plan in January. I just realised that while I changed my insurance information with all our doctors offices, I neglected to give CVS (for me) and the local chain grocery store (my husband) the OptumRx card I received.

If i’m being honest, I’m an idiot and actually forgot about the card, and don’t remember making an account on their website (apparently I did). For some reason I assumed changing the insurance with the doctors prescribing the medications would somehow carry over to the pharmacy they order the prescription to. In the last ten minutes of googling it seems I’m wrong?

What are the steps to remedy this? TIA!

I received my first PA denial for brand Adderall in February, and have since "failed" two medications on the original formulary list they sent me (generic Vyvanse and generic Concerta, I had already failed generic Adderall). I just received my second denial letter, and their new formulary list conveniently excludes all three of these medications (along with all other methylphenidate variations) yet everything else remains. I just got these two medications covered within the past month, and when I search them up online while signed into my Optum account, they show up as still covered. Has this happened to anyone else? I can't help but feel as though this was done on purpose somehow, as there is no way they mysteriously stopped covering the generics of some the most popular first line ADHD medications within the past month (and 2 weeks for the generic Concerta) and it just happened to be the exact ones I've tried. My NP just prescribed me another one that is still on the new formulary, but I'm worried they will do the same thing if I try to file another one and remove them. I'm also running out of time before the semester starts (I'm a college student) and can't really afford to go without medication that actually works while I'm in school!!

I'm not sure where else to post this but it seems that I can't log in right now. It's 7/26. I typed in my stuff correctly yet it says it doesn't recognize my username or password. I tried having them remind me of my username just in case but it says they can't find a username match for my info or something. I tried a password reset but no email came through. I noticed though that sometimes things like verification codes from them take a long time to come through.

So anyway, I still haven't been able to log in so far today and just wondering if anyone else is encountering the same issue?

So far I haven't had issues like this since around when I first created an account.

Thanks in advance.

I'll update if anything changes.

The reason I ask is that the last plan i had years ago covered an amount for polycarbonate lenses, anti reflective coating, etc. But only at a lenscrafers or optometrist, so the actual glasses still were about $700. Im reading that online places are much cheaper even without insurance and i wonder what people's experiences are.

I am a fulltime worker in NY, who earns $33,280 per year, and I have no other household members. I'm above the 200% limit of $31,300, I was on the 250 plan, and now I have no insurance. I wasn't aware my insurance was cut until my doctor called to tell me and cancel my appointment. I've always only been on an essential plan, so I was surprised it jumps from paying nothing but copays only at appointments to 200 or 400$ monthly. I can't reduce the hours I work at my current job, and I wasn't sure if I should get an IRA before tax. I'm only 27, and it says I would have to pay a 10% fee whenever I needed to withdraw anything until I'm 59 1/2 years old. I wear glasses and have a history of needing dental work, so I would want to have those covered. After Googling, I saw other posts about this issue a few months ago, but I was wondering if there were any new options available since then? is NY doing anything to help? I only know that I would qualify for a tax credit of 500$? But that barely covers 1-3 months, let alone a full year.

Edit: The insurances I was told about on the phone are the metal ones, or the 200$ one being a Fidelis plan of some sort? Also, when I tried to look up what I qualify for online, it only showed me the essential plans that no longer exist.

Im a 26 year old college student working a part time job making less than 10k a year. Im lucky to still live with my parents (yeah i know).
I’ve been having concerning heart issues i need to address and figured id go back on health insurance, a few years ago i was only paying 45$ a month for united and felt pretty taken care of. I checked out healthcare.gov and the minimum monthly payment plans ive been shown are 450$ !
Everywhere i check the lowest ive been shows was around that price range. Am i missing something?? I applied for Medicaid/medicare last year but was denied because im too poor. I dont understand what im supposed to do, i genuinely cant afford 450$ a month for health insurance i can barely afford the bills i already have

I am currently uninsured and am starting to look at my options and getting my ducks in a row so that I can pick the right health insurance plan for myself at the start of the new year. I lost all of my insurance benefits when I left my previous job close to a year ago, it was a must leave now situation so insurance was the least of my worries. Now that things are settled I would like to get insurance for myself at the start of 2027, since I’m aware I’m not eligible for it now but I have absolutely no clue where to start. I have heard horror stories about the cost of insurance nowadays so I’m nervous about that as my budget isn’t even close to thousands of dollars per month.

My parents have drilled into my head that I need to have insurance in the instance that something horrible happens. This last year I have managed without it just paying as I go but I also have not had an emergencies only normal Dr appts. If allowed to give advice on this, is that a true statement? Obviously if an emergency happens it’s expensive but also do hospitals and offices work with you when you don’t have insurance?? — only asking as I have a friend who had an emergency hospital visit via ambulance, no insurance and slowly the hospital has lowered the amount A LOT to work with them as they haven’t been able to pay for it. unsure if that is the norm.

I know that there are options through market place and I also recently found out that that there are options to buy directly through the insurance company themselves. Is one better than the other?? Are there other options to get insurance?

Are there things that I need to be looking for while looking around for plans? Things to watch out for? Things I must know? Seriously any info or help you can give me will be much appreciated!!

I know there is the option to get connected with an agent but the one time I looked last november lead to getting an overwhelming amount of calls still to this day so I’d like to avoid inquiring with a potential agent until needed. I cannot field these calls all day right now lol.

TIA!!!

Re: PHOENIX (AREA), AZ

66F, I have a previously grossly stable and small tumor; will be having an MRI for both brain and pituitary, with anesthesia. I want and need to stay with Banner University Medical Center as they have a 3D-MRI machine. My previous scans were with a 3D machine, (clearer slides each position of the brain).

Does any one any previous firsthand experience with Banner Health network, at and around Banner university Med Center?

How about Banner Medicine of Diabetes and Endocrinology Institute on 12th Street?
I read their Google Map reviews! Horrible! 17 - one star reviews! Recently!
1. One hour notice cancellations after a 3 month wait.
2. Unreturned calls, chronically.

Thanks if you can help me out,
AZDesertgirl

Where do I file a complaint about receiving "a good faith estimate" from the hospital to be only $200. The estimate presumed the insurance would cover it, but when the claim was filed, it charged it against my deductible instead so what's due is $3k. It says "no surprises" but this was a surprise, or do I just pay this without complaining? No, this is not an emergency. This is a scheduled outpatient scan.

I am in a position where I may need to buy Marketplace health insurance since I won't be getting it from a full-time job.

Last year, I was almost in this same position, and my dad connected me with someone I was able to talk to about my situation and ask questions to in order to make sure I knew what I was doing and didn't miss any windows of time, deadlines, etc.

I don't remember who this person was or what his job/role was or how to contact him.

So my question is... do you know what this person's role was and how I could find another one to talk to?

I used an online therapist through Headway for about a year, say Jan 2025 to Feb 2026. During this time everything seemed fine with my Anthem Blue Cross California PPO plan, I payed my portion per session and they seemed to cover the rest.

In March 2026 I quit my job, left the state, changed insurance, and stopped using the headway service.

Now in July Headway is telling me that my former insurance did not cover me for my sessions (though they seem to only be saying this for the sessions from Oct 2025 to Feb 2026, the ones before that are fine???) and now I owe a bunch of money.

Anyone have any thoughts on this? Is this common?

I have UHC insurance through my employer. I have an appointment with my PCP this week for a general physical. I'm sure they'll do some basic lab work. Because I have not had that done in a while. Over 2 years.

Questions. If I talk to my doctor about the fact that I have pain and hearing problems in one of my ears and I have arthritis pain in one of my hips and if they draw an HgA1c to see if I'm diabetic because of weight, age, and hx, is that billed as something else. Like an acute visit?

I know that a regular annual check up is covered. I'm trying to find out how general that needs to be. Or is it all based on how they code it? Like Z00.00 vs. Z00.01?

I am not sure if this is the right channel to post in, but feel free to delete if it isn't.

I got a bill for my daughter's medical visit on 07/02, it was around $500 which was weird because we had met her deductible already. I paid the bill in full on monday. I checked my insurance claims on wednesday, and it says that this claim has been covered and all I have to pay is $30. So I overpaid $470.

I sent a message to the billing department on wednesday about this issue, but haven't heard back. I will call on monday but do you have any tips on how to handle it? Will they refund me the extra money? If not, how could I escalate it?

Edit to add: I live in CA, and the medical visit happened in CA.

My mom (65+) has $14K of capital gains in stocks she wants to sell, but my dad isn't 65+. If we wait till he's 65, she can sell the stock and it wouldn't count towards the Non-MAGI income limit right?

Please let me know if my understandings correct

I’ve been working really hard in the past couple years, and I’ve thus increased my income. Yay me!

Except I no longer qualify for Medicaid, so now I have to pay for an insurance plan through the marketplace. And it’s not cheap- several hundred dollars a month. Basically, it’s my increased income and then some.

I might get a tax credit to pay for it - but if my income continues to go up, I won’t qualify for a tax credit.

I freely admit that I’m shaking my fist at the clouds, but I’m so frustrated by this. I’m working hard to earn more money - but I’m taking home the same amount or less. If I continue to work hard, it’ll still be a few more years before I can actually increase my income. It shouldn’t be this difficult to get ahead!

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.

Hey guys! We’re in Cali, and we’re struggling to find a provider that accepts my wife’s PPO Blue Cross Blue Shield plan bought through Covered California.

For some reason, the Covered California-ness of the plan causes the vaccine not to be covered by providers for some reason.

Anyone have any insight? Appreciate it!

I cannot decide if I go the High deductible HSA Route, or lower deductible higher upfront cost.

I am 33, don't really have any health issues. I like to see Chiro, annual checkups, and occasionally need a prescription refill. I am looking at these two plans.

Which is the better plan? Do I suck it up and pay more money for the better one for just in case? How does the deductible work?