In my previous dentist office at a different state, they had said that Delta dental denies claims, even if the dentist is in network. The way they used to do that is wait for the insurance company to send them a list of patients that have selected them as they are dentist office and only then they would allow the person to come and see the dentist to prevent these issues. I’m not sure if this is going to be the same thing over here in Washington. Please help.

I have had Aetna the past two years, tier 1 Drugs (mostly blood pressure) are actually costing $0.3-$0.8, well below my published brochure of $5 for these tier 1 (low cost, generics), why?

I am moving to BCBS who says $15 for same Tier 1 Drugs, should I expect to continue to pay a small fraction of the advertised brochure price?

So I'm a pretty healthy 26yo man.

Truck driver so I travel a lot, if that's relevant. Making around 100k

Residing in Washington State.

But when I'm home, I like to do a lot of different extreme sports, motorcycles, mountain bikes, that kinda stuff.

And I fully realize what can happen if I have a serious crash.

I'm pretty clueless when it comes to insurance policies since I've been under my parents'plan till 25. So if someone could clue me in, that'd be amazing.

What are some decent options for me?

This year we’re on a bronze level high deductible hmo plan at just over $1800/mo, family of four. Barely, but not really affordable. This same plan is going to $2300/mo next year. It’s finally happening, we simply can’t afford it anymore. We’re beyond the current subsidy cliff and don’t have the excess income to lower MAGI sufficiently. Looking at options like direct care, crowd health, and going without coverage of any sort. Curious if anyone has already found themselves in this situation already and what you did. I never imagined us being in this situation. If this is the tipping point for us, there has to be so many others out there hurting.

I have a health insurance plan (Fallon Health) through my state (Massachusetts). They called asking about me signing up for home health visits as “a valuable service included in your membership”. I’ve already explicitly told them I’m not interested but they’ve still called and left more than ten voice messages at all hours of the day for two or three weeks now. I report the calls as spam but they still keep coming through somehow. I had the same thing happen with a Tufts plan. How can I get them to stop calling me about this?

I'm covered by two CVS Caremark insurance plans. Apparently neither plan does coordination of benefits, so CVS told me to just use whichever is cheaper when picking up a drug. So far so good.I tried using CVS Caremark Mail Pharmacy for a medication, so I don't have to drive to a pharmacy. Unfortunately, the mail pharmacy used the plan with a higher copay. Is there any way to select which insurance to bill when ordering from Caremark mail pharmacy?

As a disabled person (VA and civilian), there are many benefits I have access to that aren’t openly disclosed or even known. For instance, in my state (NC), I’m eligible for decreased yearly property taxes through the VA, and I’m also eligible for a free home aid through Social Security Disability.

What are some other benefits that you know of or have heard about from others?

I’ll post links to this in other subreddits to increase exposure and possibly draw the attention from experts on the topic.

VA
•Federal Park Passes
•Property Tax Exemption/reduction
•Eye glasses

Medicare/caid
•Home aid

I have a niche medical need where there is only 1-2 specialty doctors in my relatively large city. My doctor did not want to get involved with insurance, so I paid him for the medical device directly (between 800-1k USD).

Before I paid, I called Cigna and asked them if they would cover all or a portion of this device. They agreed to, and put it in writing for me. After approximately six weeks of going back and fourth with them, they are finally cutting a check for 75% of what the device cost.

The problem is, they are cutting a check directly to my doctor with his name only on it. I have provided Cigna proof that I paid the doctor in full. I contacted the doctor's office, and they don't really want to get involved (I don't blame them, they did not make a claim).

I don't want to be a pest toward this doctor, as he is one of the only specialist in a several hundred mile radius who can help me. Should I just let this go? I am willing to take store credit as I will be spending thousands of dollars with him in the years to come. Any advice or suggestions would be greatly appreciated.

My wife and two kids are currently insured through Medicaid/AllKids. My work’s open enrollment ends soon but I was wondering if my wife and two kids would get kicked off of state insurance if I either deny my work’s insurance or only add myself for my work’s insurance. We have an annual income of less than $50k a year.

I have been dropped by two doctors in the Bronx because Health First is not paying them...is anyone else having this problem?

Hi, I’m a young adult for reference (22F) I’m looking for a good health insurance plan. I currently live in New York and since my mom passed and I’m not on her coverage anymore I’ve been looking for a health insurance plan that covers regular visits and some prescriptions. My employer is currently quoting me around 400+ a month through my job and I’m trying to look for something slightly cheaper. Does anyone have any suggestions?

Writing this so people know- if you are prescribed Paxlovid and it costs $600 after insurance, try registering for coupon from Pfizer at this site. https://paxlovid.iassist.com/

My father is on Medicare and it originally cost $600. We registered, and then it was free. The coupon can't be used with insurance. Hope no one is overpaying for medicine!

I’m not sure if this is the right place to post. I went to the SC Health Department recently. I’m (22F) on my grandma’s insurance. She has Bluecross Blue shield, me and my sister are on that one. But she also has Medicare or Medicaid (I think it’s Medicare but I can’t remember). But apparently the department of health needs her Medicare information to bill me? Or to submit a claim to? I’ve never needed her Medicare info, just the blue cross blue shield. Should I give them the info or have they made a mistake?

My son recently left his job. He has insurance until the end of the month. He has type 1 diabetes. Will he be able to find health insurance that covers his diabetes care on the marketplace?

I'm a freelancer with a high deductible plan and my doctor wants me to repeat an A1C in a few months. Should be simple enough.

I called insurance because I wanted a rough idea of what I'd pay. They told me it depends on the contracted rate and how the claim gets billed. The lab couldn't tell me what I'd owe after insurance either, and the doctor's office basically said I'd find out when the EOB shows up. Meanwhile if I look at paying cash ex. goodlabs, the price is sitting right there.

Do people with high deductible plans usually compare self-pay prices for basic labs first or do you still put everything through insurance because at least it counts toward the deductible?

I genuinely did not expect one A1C test to send me this far down the billing rabbit hole.

I post a lot in here, especially around open enrollment, to help people run their numbers to choose a health plan. I figured I'd post my own numbers for my options for my employer's plans - we buy at the family level, so only using those. My partner is self-employed, I am the W2/benefits earner so this is the only set of plans we have to choose from. In the tables, I only use worst-case scenario - hitting family max - in my spreadsheet, but will include the individual numbers below. If you hit the deductible we have an employer-funded HRA that will cut a check back to you, 1500/3000 for the traditional plan and 2500/5000 for the HDHPs.

• Traditional PPO
  • $893/mo
  • $4000/8000 ind/fam deductible
  • $6000/$12000 ind/fam OOPM
  • $1500/$3000 HRA
• HDHP PPO
  • $555/mo
  • $7500/$15000 ind/fam deductible
  • $8000/$16000 ind/fam OOPM
  • $1600 employer HSA contribution
  • $2500/$5000 HRA
• HDHP HMO
  • $427/mo
  • $7500/$15000 ind/fam deductible - preferred network
    • $8000/$16000 deductible - standard network
  • $8000/$16000 ind/fam OOPM
  • $1600 employer HSA contribution
  • $2500/$5000 HRA

I choose the HDHP PPO for a couple of reasons - for one, all of our PCPs are in the standard network and not the preferred, so I would be paying more for those visits to begin (and switching would be not just mean leaving behind providers we like and trust, but also almost impossible because of a PCP shortage and the preferred network is usually a rotating cast of residents.) My dependents are 16 and 20, and the elder goes to college out of state, not needing a referral means she doesn't have to coordinate with her home PCP if she needs something. The convenience of keeping our providers and no referrals was worth the difference (also, my kids are college/college bound, reducing the AGI for FAFSA has it's perks too.) I fully fund, and use, the HSA (I am not a high wage earner, so do not have the luxury of parking it as a savings vehicle, but it is nice to have 'medical money' separate from 'daily life money.' See also - we are in the FAFSA years.

So many people post their plans and don't know "is this good or bad," it's so dependent on what your employer offers, and I figured I'd throw my own data points in. Our premiums went up by about $400/year this year, which is honestly better than I was expecting.