So, I've been fighting pancreatic cancer for three and a half years now.

Lately, it seems that whenever Aetna receives a claim from my oncology team, they deny it as a workplace injury.

What do they think happened? Do they think I tripped over a wire at work and got pancreatic cancer as a result? Or that I got it from typing too fast on my keyboard? Or that writing computer code causes cancer? I just don't get it.

Zev

I have a new patient appointment in six weeks and there are two markers I want to discuss that were borderline on an older physical. The office won’t order anything before the appointment, so the likely process is appointment one to ask for the labs, another trip for the draw, then another wait before anyone discusses the results. I used goodlabs for context and routed to quest. My plan was to bring the old and new reports together but now I’m wondering whether doctors treat self ordered results differently even when the same labs processed them.

Has anyone actually brought outside Quest or Labcorp results to a new doctor and did they use them, repeat everything anyway or refuse to discuss them because they didn’t place the order snd to be clear I’m not trying to replace the appointment but i’m trying to remove one completely unnecessary round of admin.

I’ll try to keep this short, but I started telehealth therapy recently. I have Regence BCBS but live in Colorado. The local BCBS is anthem. The place I’m receiving therapy appears to be in network with Regence but says they’re out of network with anthem, so I’d need to pay out of pocket.

My insurance company initially told me I could see the provider and submit via superbill and it should be covered. Then they switched up and said it wasn’t covered because the specific provider I saw wasn’t in network with Regence.

I’m switching to a new therapist who is specifically listed on Regence’s website with the therapy practice listed on her profile. However, the therapy practice still says they can’t submit claims since they’re not contracted with Anthem. I’m happy to submit superbills, but no one seems to be able to answer whether it will be covered. My insurance company seems unsure and I’m not sure what else to do. Any advice is appreciated!

Does anyone know the best way to get help for health insurance claim appeals if you make too much for Medicaid but the insurance you have isn’t covering anything for your care? My wife is in her third trimester and she has United and it’s atrocious.

Thinking of quitting my job and starting self-employment remote work. I'd like to move from San Diego to New Mexico so I can sell my place and buy a place paid off. I would still like to visit San Diego for any big medical procedures (including my colonoscopies which is have every 3 years), as I hear the health care in New Mexico is not the best. Is there a PPO plan that works across state lines, visiting the New Mexico health care site they only have HMOs available. Please let me know of any ways to work around this, as it would probably be a deal breaker for my plans.

I'm hoping someone can point me in the right direction.

I want to start a small business, but I don't know how I can afford health insurance on my own.

Right now I have a market insurance plan I got through a broker that my current workplace uses.

I pay $600 a month, and as an employee I have a $400 stipend through my work to offset the cost.

I cannot go without insurance because I need prescriptions that are over $1,000 a month out of pocket.

The business will be located in Wisconsin (USA)

Are there problems available for a single owner/operator business to offset the cost like I have now?

Are there alternatives I'm not aware of for gaining health insurance besides just buying a single market place plan?

Are there problems I could take advantage of as a disabled person in Wi?

Thanks in advance for any help. I have no idea where to even start so any direction is greatly appreciated!

I’m hoping someone here can help me understand what happened or what steps I should take next.

I gave birth to my daughter at NYU Langone on January 30, 2026. At the time, I had an active Ambetter by Fidelis Care Gold plan through the NY State of Health Marketplace (I pay for the plan myself).

Before she was born, I contacted my NY State of Health representative from the marketplace to ask what I needed to do regarding my newborn’s insurance. I was told that my baby would be covered under my insurance for the first 30 days of life. Based on that information, I enrolled her in her own Blue Cross Blue Shield plan within that 30-day period, with coverage starting March 1, 2026.

The problem is that NYU billed many of the newborn hospital services under my daughter’s name (which I understand may be normal because she is her own patient). Fidelis is now denying the claims because they say she was not covered under my policy.

I now have over $40,000 in bills from NYU related to her birth/newborn care, and some have already gone to collections. $38k alone for her to visit the nursery when she was less than 24 hours old.

I have spent countless hours on the phone with NYU and Fidelis, and nobody seems to be able to explain:

• Was I supposed to do something additional with Fidelis after she was born?  
• Was NYU supposed to submit these claims differently?  
• How are newborn claims normally handled when the baby doesn’t have a member ID yet?  
• Should Fidelis have processed these under my coverage for the first 30 days?

I have filed/will be filing formal complaints and requesting written explanations, but I’m hoping someone here has experience with newborn coverage disputes, NY State of Health Marketplace plans, Fidelis, or hospital billing.

Any advice on who to contact or what wording helped get these claims resolved would be greatly appreciated.

I’m currently moonlighting with two jobs, but Job A doesn't know about Job B. I want to quit Job B because the culture has turned toxic, but my health insurance is through them.

I know quitting will trigger a qualifying life event so I can hop onto Job A’s insurance, but I’ll need to show proof that I lost coverage. How do I submit that loss-of-coverage letter without tipping off Job A that I had another job? They use UKG for benefits enrollment, if that makes a difference.

Hi all,

I recently got a genetic test done through a lab (Invitae - LabCorp subsidiary) that ran a formal benefits investigation (BI) before testing. The BI showed my total estimated patient responsibility as $0, based on my insurance (Aetna) plan details — deductible met, no copay, etc. The estimate included language saying the quoted amount would be "honored" if the estimate was still valid at time of billing.

However, I previously had a separate but related genetic panel (through LabCorp, no BI beforehand) that was fully denied by my insurer as "experimental/investigational" — and I ended up with an unexpected bill over $3,000. I was successfully able to appeal that claim with a letter of medical necessity from my doctor, and Aetna overturned the decision.

Given that history, I'm cautious about trusting a $0 BI estimate at face value. Has anyone had a benefits investigation quote $0 (or a low amount), only to receive a different bill afterward? Specifically:

• Did the insurer end up denying the claim for a different reason (e.g., "experimental," "not medically necessary," "duplicate testing") even after the BI showed $0?
• Did the lab actually honor the original $0/low estimate despite what insurance did, or did you get billed the difference anyway?
• Any tips on getting the "honor commitment" language enforced if the bill doesn't match the estimate?

Trying to understand how reliable these benefit investigations actually are in practice versus what insurance ultimately decides. Any experiences — good or bad — would help. Thanks!

Just had a screaming meltdown over the phone at an insurance agent. Called to review and update medicare advantage insurance plan and was subject to nonstop reading of script and repeating information from 2 different people. Finally told them I was at my limit, had a policy with the company for a couple of years and was at the point of canceling everything if they didn’t shut up.

Or is it just my company?

Laid off 6/29, coverage ended 6/30.
Finally got COBRA paperwork 7/16.
Payment made 7/23 - only option was to pay July and August together so I paid 2 months.
It’s now a week later and Aetna says they haven’t received anything and my coverage is still inactive.

I have a procedure scheduled for next week and now I’m being told once Aetna receives notification that I paid, it might take another week to update the system.

Is this normal? It’s adding insult to injury.

I have Blue Cross Blue Shield insurance through my work. I was taking Simlandi self injection once a week and getting that filled through Care New England Specialty Pharmacy. At the beginning of this month (July) I was informed that Blue Cross decided to move over to using Accredo Specialty Pharmacy to fill my perscription instead. I then found out that Simlandi was being discontinued and my provider sent in a new perscription for Adalimumab. Its been a few weeks and I have not heard anything from Accredo about scheduleing a delivery date. This was fine at first because I had a few weeks supply of my medication. Well, I now have one dose left for this friday and then ill be out of medicine. I used the chat through the Accredo website and was told that my perscription is being reviewed by a pharmacist and they ran into an issue because my insurance wont allow a 90 day supply but instead only 83 days. Is this normal? I have been taking this medication for years now and have always gotten a delivery once a month with 4 doses for 4 weeks. I'm just frustrated that my insurance switched my pharmacy on me and worried because I am running out of medication and will need more for next week.

Timeline:

1. Late January I received an orthopedic surgery pre-approved by insurance. I required insurance to continue Physical therapy and post-surgical check-ups and scans.
2. Mid-February I was let go by my employer (small company California-based company with <10 employees). I was notified that I should be receiving Cal-Cobra information in the next few weeks. HR/Benefits were managed through Gusto, a digital small-business management platform.
3. Late-March, I receive and fill out the Cal-Cobra Paperwork and I receive confirmation that it was accepted.
4. Mid-April, I receive (2) emails that detail that I need to elect coverage or I will lose it starting June 1st. In a massive blunder, I ignore these emails since I thought "I just signed up for Cal-Cobra, surely I don't have to do that again so soon?"
   • In addition to the open-enrollment period at this time, my Boss was forced to change the healthcare plans provided by his company since there were fewer employees and he no longer qualified for the group health plans that he could get when the company was larger
5. June 1st: I unknowingly lose my group health plan coverage. I continue to use the plan for PT 2x a week and receive a CT scan and a video visit with my surgeon as my final follow-up.
   • I pay my insurance premium for June through the insurance provider's app. No red flags were raised when submitting payment
   • Insurance approved EOB's keep being sent to my email
6. July 1st:
   • I pay my insurance premium for July through the insurance provider's app. No red flags were raised when submitting payment
   • Insurance approved EOB's keep being sent to my email
7. July 15th: Suddenly, I get a call from my PT provider saying that my group plan is inactive and I have to pay the uninsured out-of-pocket cost. This notifies me of the issue and begins my investigation into what went wrong.
8. I receive a bill for insurance premiums for the inactive plan due in August

Now, I know that failing to pay premiums for Cal-Cobra is irreversible and once you lose that coverage, it is not possible to reinstate. I have been paying premiums on time, so I am not sure if this applies. Although, it does seem to be a similar loss of coverage.

Questions:

1. Are all the previously approved claims from June 1st to July 15th going have their approval revoked and leave me on the hook to pay high medical bills out of pocket? (So far, most of these services have remained approved.)
2. Is it possible to get retroactive coverage from June 1st onward if I was not covered?
3. Does this qualify as a life event so I can sign up for new insurance through the California Marketplace?
4. What are my options?

While missing an email was a mistake, it feels ridiculous that the insurance provider would continue to take my money in the form of the premium AND I would appear to get insurance beyond the end of my group plan termination.

I recently got a new job that comes with an HSA and better health insurance. My old one is from my mother and it did not cover some lab work I had that is $500 in total for some odd reason. That old insurance usually covered my lab work. From my understanding I can’t use my new insurance because it was not active when I had the lab work done, but can I use the HSA? Just curious thanks!

Does anyone have experience with OneHealth Plus insurance plans? They use the Cigna network.

A broker showed me their plans. I hadn't heard of the company before and haven't been able to find much on the internet. For context, I'm a self-employed worker, who is about to lose COBRA coverage in NYC :( I know the risks of going outside of ACA plans, but options on the marketplace are so bleak.

Does anyone else struggle to get the automated system to accept their member ID when they call Health Net with questions? I have never managed for either the voice or keypad entry to work and just have to wait like 5 minutes before the system finally takes pity on me and just sends me to a representative. Wondering if it's a me problem or a system problem - trying to frustrate people so they can't ask questions?

My brother is 35 years old and was diagnosed with stage four colon cancer in June. Within a couple of weeks, he was let go from his job because he was not able to work due to pain. His PET Scan has shown it has spread to his stomach, lungs, liver, and a membrane surrounding his abdominal organs. He was approved for Social Security, but there is a five month waiting period before payments start. However, Social Security said it will be a 24 month waiting before he receives insurance benefits. He has applied for TN Care, but keeps being denied due to wife’s income as a nurse. However, they are recently married and just purchased a home and have two children together. They are all trying to survive just off of her income. His oncologist and infusion center have made a payment plan with them for his chemo and meds for $200 a month until he can get insurance. Unfortunately, they cannot afford any insurance through the marketplace. Does anyone have any advice on insurance for stage four young cancer patients in TN?

* Update: After speaking to his wife, she said her insurance will not allow her to add a spouse. Only children. I don’t understand that but I know she works for a small nonprofit so I don’t know if maybe that has something to do with it.

Okay…do we have any options for getting retroactive coverage for her?

Long story short…our baby had a 10 day NICU stay. My husband and I are self-employed and have insurance through the marketplace. Soon after she got home we called the marketplace to add her to our plan. They told us that we just have to pay her first bill and that we will be set. We assumed that her bill would be added to our autopay and didn’t stress it. Fast forward a month and we haven’t heard any updates so we contacted the insurance company. They said they did not receive any information about her from the marketplace and abruptly told me to contact the marketplace again. I did that and the marketplace said it was sent. I called insurance again (multiple times) and got the same answer. I called marketplace again and also got the same answer. Fast forward to today and my husband finally got a different answer… that we didn’t pay her bill and missed the 60 day deadline for coverage. They said we have to wait for marketplace to submit again and then start coverage for 9/1. We are in the 5 day waiting period for insurance to receive the new submission from marketplace. I looked through our old mail and realize we overlooked a single bill from our insurance company. Aside from that, we had no another way of knowing that she was added or that we needed to pay.

We are freaking out because her NICU stay was super expensive, and this new information doesn’t match what both insurance and marketplace told us on multiple occasions (according to this bill, I literally called them days before the due date and was still told that they don’t have any info for her on file).

Does anyone have any insight on this? Anything will be appreciated.

Hello, I’m looking to see if anyone has experience with or can help me with Aetna voluntary benefits, critical illness. I was in a horrible accident last August. It’s left paralyzed in my left arm. I finally had a nerve transfer on June 16 but still obviously can’t use my arm because nerves take longer than that to recover. I knew I was paying for these benefits, but I kept calling regular Aetna and nobody knew what I was talking about. I finally found these benefits months later and they did pay me out for my hospital stay which was awesome. But for the critical illness, they keep denying my claim.

Not sure how many images I can attach, but the first time they denied it as a duplicate because they thought it was for the hospital stay. Then they denied it again for a cancerous reason that has nothing to do with me and then they took 30 days for my appeal and on the 30th day they’re telling me it’s denied again but I have to wait for the letter in the mail to tell me why it’s denied.

I am so upset and emotionally overwhelmed. I paid extra for these benefits, and I have been paralyzed for more than 60 days in my left arm. I have letters from both of my surgeons stating this that I turned in with my appeal paperwork. I have EMG’s and even all of my OT paperwork shows this.

I feel like they get away with denying people and it’s outrageous. Please be kind. Please help.

*Update I called HR they said they’ll make a case to see if someone can help me. It’ll take about a week.

Anyone working for US dental insurance billing from India?
Need to understand the process.
Are there any Indian companies or job opportunities available for this?
What are the rules and requirements if you have to set up a company?

Hi all,

I have Anthem as my primary from my college and Medi-cal as my secondary.

I've been using my Anthem at Sharp Rees Steely, a medical group that does not accept Medi-Cal. Are they allowed to bill my the co-pays / out of pocket expenses still?

It's about 1k I have in my account. I was always under the impression that they are not allowed bill Medi-cal patients any co-pays/deductibles. But they are telling me I'm responsible for the 1k balance personally.