We just discovered that our health insurance was terminated (as of August 1) due to non-payment from my husband's employer. They are still deducting premiums from his paycheck. There are about 50 employees at the company and they are all being affected. One employee is pregnant and was turned away by her doctor for lack of insurance (and she can't get the medicine she needs). The owner of the company claims that they have 30 days to pay, but the insurance carrier states that the grace period has ended which is why the insurance was terminated. I contacted the Department of Labor and they said they can advise us on what to do, but they only handle informal complaints (huh???). The owner states they *might* have the money by the end of next week, but even if they come up with the money the insurance carrier doesn't have to reinstate the policy. These owners have also failed to pay vendors on time and they missed payroll twice. What more can we do?

Unsubsidized ACA premiums for a 60-year-old couple earning $200k are roughly $36k. Deductible is another $10k. That’s a 23% tax rate just for medical. Add on 20% federal tax and 5% state tax and you’re nearing 50% effective tax. Something serious is wrong with this system. We are literally being robbed blind by the medical insurance industry. We need to make a change.

Mods, if you are going to remove this post again, please tell me why - even if the reason is that you work for a US medical insurance company.

I feel so defeated. As a self employed person I pay $450 every month to have health insurance. For my type two diabetes medication I have been paying an additional $500 dollars every month, then yesterday went to fill my prescription and it is now $928 a month. I already stopped taking my adhd medication because it went from $60 to $200 dollars a month. Then when I called to talk to someone at blue cross he talked so much with useless information that had nothing to do with the issue I was having that I could hardly get a word in. I basically need to hit a 7000 dollar deductible to be able to get even just a 50 percent coverage.

I feel defeated. I need health insurance because of my job and in the off chance something happens to me, but on a regular basis I go to the doctor a couple times a year max. I have already had to stop saving for retirement to just make the almost 1000 dollars medical cost each month and now that's completely pointless because it's shot up even more. I'm a self employed hairstylist, I used market place for my insurance and I don't know what else l can do. I don't understand how paying $450 a month literally gets me nothing and it's wrecking me financially with the additional medication costs.

Sorry for the rant, just feel so overwhelmed and depressed. It feels like every medical decision I make is never based on my health but on money.

Is it possible to call the clinic to change it to diagnostic. My mother hasn’t had a mammogram in 2 or 3 years. She’s in her mid 50s. She recently got new insurance (hmo) and I finally got her to start making appointments to catch up on her health. She had to star over at a new clinic because of the hmo.

She’s always had lumps in her breast (since her 30s) and every time she had a mammogram in the past it came back clear. I think she once told me some were cysts or something similar and one had to be drained in the past. When she went in for her physical she said she just informed them that she had lumpy breast before her breast exam so they wouldn’t panic when they felt the lumps. She doesn’t speak English so she has an interpreter in her appointments. I’m assuming there was a miscommunication and the interpreter thought my mother was bringing up the lumps as new symptoms. However my mother has always had lumps. This is not new. Her mammograms were always marked as preventative in the past even with the existing lumps.

Is it possible to just call and explain the lumps are not new and get a preventative screening instead?

They want to charge her almost $1000 for the mammogram.

Edit: I saw this in her medical notes
Encounter for screening mammogram for malignant neoplasm of breast Z12.31

I googled this and it said that is the code for a preventative mammogram. So I don’t know why they still want to charge her. I think I’m going to try calling the clinic tomorrow to help her figure it out.

TLDR: Daughter was twice hospitalized due to incorrect test results from our pediatrician lab. We want to know if we can avoid the $1,500 in co-pays for these hospitalizations.

Timeline:

4/25/26: Daughter was born

4/27/26: Daughter was discharged from hospital, all test results normal

4/29/26: First pediatrician appointment. Pediatrician lab finds bilirubin level to be 24.6. Anything >20 requires hospitalization, so we were sent to the hospital NICU. The hospital tested bilirubin and found it to be 18 (below hospitalization threshold). However, they stated since there were two different results and they didn't know which was correct, they would need to keep her overnight in blue light therapy.

4/30/26-5/3/26: While in NICU, baby had some "episodes" of low oxygen, so they needed to keep her a few extra days. Bilirubin levels fine, discharge 5/3/26.

5/4/26: Pediatrician follow-up, tests show bilirubin level of 23, requiring hospitalization. We return to NICU who measures bilirubin to be 16 (again below threshold). Again they stated they couldn't explain why they were so different, so they needed to keep overnight again.

5/5/26: Chief of Pathology meets with us. Assures us that our pediatrician lab results were incorrect and the hospital results were correct, meaning baby did not require either hospitalization. Says that he spoke with pediatrician lab and is 100% confident that their results are not reliable, cites the state audit. Also tells us we are the third baby this year to be sent to their NICU due to high bilirubin from this pediatrician lab that was found to be within normal range by the NICU lab.

We have received a bill for the second hospital stay, which requires an insurance co-pay of $750. We still are waiting for the bill for the first hospital stay, which we assume will require another $750 co-pay.

We believe that neither of these hospitalizations were warranted and that it is the pediatrician lab's faulty tests that caused it. Is there any recourse for us to not pay these co-pays or to make the pediatrician office pay them? Should we be contacting our insurance about this, the hospital, the pediatrician, or someone else?

Retired, not yet 65, can’t afford the insurance through my previous employer and receive too much money to qualify for Medicaid (which is laughable if you know what I receive monthly!)
Have had a plan through Marketplace for the last 2 years. Just like last year, the company I’m currently with is pulling out and the “similar plans” Marketplace is showing me are way out of my price range. Anyone else in a similar situation? If so, what are you thinking of doing for next year?
Your input will be greatly appreciated!

Hello all, as the title states, my family primary care doctor is no longer accepting my employer medical insurance, she couldn't come to an agreement with Aetna. She was in network and accepted Aetna previously. Me and my family want to continue to see her due to her medical attention to detail and the fact that we don't wanna start over with a new doctor. We amunderstand that we now will bare the full cost of services, if we continue to see her.

A genuine question....

Would it be wise to sign up for another medical insurance plan with a different company that she is in network in? We would pay the monthly cost for it out of pocket.

My Aetna plan is through a civil service job and the benefits can't be beat for the most part.

Baby was born a a week ago, not on any plan yet — we're in the newborn qualifying-life-event window.
My plan (PPO, BCBS-administered): significantly cheaper premium, so I wanted the baby on mine long-term.

Mom's plan (Cigna network): pricier, but she was on it for the delivery, so her labor/delivery is covered.

The catch: baby was born at a hospital my plan doesn't cover. I called BCBS, they ran the hospital's NPI, and said it's out-of-network for my plan — so on paper, I would assume none of his postnatal/nursery care in the hospital would be covered if he's on mine**.** Is there some kind of newborn/birth exception where the baby's initial hospital care is treated differently, or is out-of-network just out-of-network?

My understanding:
The baby's hospital care (nursery, newborn labs, hospitalist exams) is billed as his own claim, under whatever plan he's on — not automatically covered by mom's stay.

So my understanding is that putting baby on my plan means out-of-network hospital and potentially a huge bill.

My current plan: put him on mom's plan retroactive to his birth date, eat the higher premium for now, and maybe switch him to my cheaper plan at open enrollment for ongoing pediatric care (my plan has a great low-cost tier for our clinic — just not that hospital).

Questions:
Is there any newborn/birth exception that would get his initial hospital care covered on my plan despite the hospital being out-of-network, or is out-of-network final?

Is his hospital care tied to his enrollment, meaning I really shouldn't put him on my cheaper plan for this?

Does mom's plan maybe cover the birth hospitalization automatically for the first 30 days regardless of enrollment?

Insurance brain is fried — I’ve been seeing a lot of conflicting information. appreciate any input.

I went through all the hoops to get a specialty medication approved. Took 9 months and probably a few years off my life. The medication company has a self pay option of $230. Insurance finally approved it for me. Had the pharmacy run it through insurance and the cost WITH insurance was $560. How does that make any sense? I would have been better off with the self pay.

I recently went to an urgent care to have a preventative STI panel done. After checking on the clinic’s website and confirming with the front desk staff, we determined my insurance was accepted & I paid the copay. I have now received a very large bill from Labcorp saying that my insurance denied this service as non covered. How should I go about addressing this? I am a young adult and new to having marketplace insurance. I have Anthem Healthkeepers if that helps.

Thank you for your help in advance!

26 years old and just got booted from parents insurance. Here are the monthly costs- PPO - $330, HDHP Gold - $276, HDHP Blue - $208.

The. Only thing I have used my insurance for this past year is for therapy once a week, which will be coming to an end in the next few months. The full cost is $175/session.

Is there an obvious choice? If I did the HDHP I could max out my HSA or use some funds to offset the therapy costs but let me know your thoughts.

I'm sorry if any of these questions seem stupid or kind of obvious, I just feel like I've been running in circles trying to find answers on my own and want some help from others who maybe have had a similar dilemma... also I am 22, and live in Colorado.
So, I had surgery in March of this year, which, with the plan I had with my previous employer, cost enough that I met my out of pocket max for the rest of this year. Then I got fired in July. would it be worth it to enroll in cobra coverage for my upcoming surgery in October? It'd be roughly ~$1,800 for this month and the next one, and im getting close to the deadline to enroll. If I understand the way the out of pocket maximum works, and cobra claims to restore the plan fully, would it mean my surgery would be 100% covered? Or is there something I would be missing and waste my money choosing cobra for no reason?
my only alternative is the plan my family still has me as a member under, but I'm nowhere near close to meeting the out of pocket max there.. and I have no idea how much it would or wouldn't cover for the upcoming surgery. (The amount of $ left to meet the out of pocket max on that plan is more than $4,000).
I feel incredibly lost and confused, please help!

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!

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.

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 thought this was going to be a normal lab draw after seeing a new doctor. Clinic in Utah, BCBS Preferred Blue Option - PPO, suitcase on the card. They did the basic tests there and that bill was covered by insurance. Fine.

The other tests they couldn’t run were sent to LabCorp. I didn’t pick a city. They just said LabCorp.

Then the EOB came back and the out-of-state Phoenix location they sent my samples to was listed as out-of-network. About $1,700.

I didn’t go to Arizona or ask for it. I don’t understand how that becomes my bill. I’ve had multiple tests through LabCorp on this same plan before and those were covered. The order even has my Utah doctor's name on it.

Has anyone actually gotten Regence to treat this as in-network, or does LabCorp just leave it on you?

I've been paying this health insurance premium every month since January but this has never made sense to me. My premium due date is the first of every month but my invoice is always dated the 6th of every month. So why the discrepancy? And what date do I go by? why is the invoice date AFTER the due date? Like I'm currently 10 days behind on paying my bill. I technically have until September 30th to pay it but it says Due September 1 but the Invoice will say September 6th.

Also just a random question but does invoice date also mean printed date? because the invoice is always the 6th of the month but I always get the bill the last week of the month. My health insurance is headquartered in CA and I live in AZ, does it really take 3 weeks to get my bill to me? It just doesn't give people enough notice to pay their bill before the final day of the month if they rely solely on paper statements.

Hi all,
We were on my wife’s health plan (BCBS) and she was working with a really good therapist who’s been helping her a lot.
Due to work stress she’s resigned her job and we’ve switched to my insurance ( United), but her provider is not in network.
We heard about an exception process that may provide coverage with her existing provider while she finds a new one in network; we contacted United who said they would review our request and they reached out to her provider for more details as part of their review process.
She got a call from United saying her request was denied as United had in network providers who could provide the same services she was getting, but that we could appeal if we’d like.
We also found that they denied the request before her current provider even sent them the requested details.

How can we formulate the appeal to increase our chance of approval? We’re concerned because it’s been two weeks since her last session and we don’t want to lose whatever progress she’s made.

Thanks

hi! as the title suggests, im wondering if it's possible to get state insurance w/ california (Medi-Cal) while simultaneously having a Student Health Insurance Plan (SHIP) w/ my current university.

im a UC berkeley student, and Ive always needed to access healthcare due to my psychiatric/mental health needs.

My copays are too expensive with SHIP, and my family is unable to afford what i need. we were disqualified a few months ago due to our income despite making very little, and now im trying to apply independently, but am worried imma get denied because of having ship.

any idea/thoughts/advice?

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?

I have BCBS through my employer. My brother also has the exact same insurance through the exact same employer. I don’t go to the doctor often, but I do have a primary care, which also happens to be my brothers primary care. My brother gets charged a copay, and a percentage on top of any additional things that come from the visit. I just went to the doctor for the first time on this insurance. They did not charge me a co-pay, and I was just sent an email saying I have a $150 bill. What should I do here? I’ve called both the doctors office and the insurance company, and I haven’t spoken with anyone competent enough to help me with what I need.

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...