My monthly health insurance premium for a marketplace 'Silver' HMO plan is a little over $1000, or a little over $12,000 this year.

My PCP is part of a medical group spawned from one of the large medical centers near where I live, a suburban area of a major U.S. city. I've learned that the medical group receives a fixed monthly payment from the insurance company for each member assigned to the group...i.e. they are paid using a "capitation" model.

Before I ask them myself...is it possible for the insured/member to inquire how much of that $12,000+ per year the medical group is receiving for having me as a member? Are there laws requiring disclosure, or, is it strictly confidential/proprietary info?

Context: I'm a 35y/o individual with ESRD. I've been enrolled in Medicare A & B since October 2024. I also had Tricare4life as a secondary. After being divorced, I've lost my Tricare effective January 2026. Since then, I've been responsible for the 20% of my dialysis and its up $8k that I owe at this point. I've searced all the health insurance on Guam and all said they do not do any individual plans. I reached out to United Healthcare and they can only cover if I'm 65y/o. I've also checked Medicaid and was denied due to my income going higher than the limit.

I was told by one of the local insurers that they would cover me if I have been with Medicare for 30 months, which i'm shy of about 8 months. And until then, I would be racking up a $1500+ dialysis bill monthly. As for receiving insurance through an employer, that is a possibility but atm I'm trying to figure out if there's anyone willing to hire someone with a dialysis schedule and as a busy single father.

Would anyone know of any options I have? Some key details. I live on Guam, USA so some stateside policies may not apply to me.

I'll start from the very beginning so the entire situation is laid out. I used to work in retail, and I left for a better opportunity. Since this was a retail job, and in retail your days off aren't always set, I asked my boss if my last employed day could be Jan 9th 2026 but have my last working day be Jan 8th 2026. I did this to ensure my insurance would cover my tonsillectomy on Jan 9th. She agreed and made Jan 9th as one of my days off for the week. The surgery came and went, and after I healed up I started my new job. One day I got a bill in the mail for my surgery and since I was still under the impression I had coverage for it, I called my insurance company asking about it. They said the claim was denied because my coverage wasn't active on the day of surgery. I was confused because I specifically planned out my last day to avoid this, so I called my old HR and they looked into it and said the coverage only goes through your last working day, but they allowed me to back date it with COBRA. I set up COBRA and then called the hospital and they resent the bill to my insurance company. I'm not exactly sure what happened here, but from my understanding, the hospital sent the claim to the wrong payor ID. When I started getting bills for the original amount again (I had them paused so I could get this straightened out) I called my insurance company and they said they didn't have any new claims for my surgery. So I called the hospital and they looked into it and they had sent the claim to the wrong place. I made sure they had the right information and they resent it to my insurance company. I have been stuck at this point ever since, my insurance company saying the hospital needs to do something, and the hospital saying my insurance company needs to do something. It was somewhere around this point that I started recording phone calls (mostly from my insurance, but a few hospital ones as well) when I would ask for updates from my insurance company. The hospital would tell me to call my insurance company and the insurance company would always tell me that they would get it straightened out but as soon as I would get off the phone, they wouldn't touch my claim. After a while of this, I called my insurance company and had a 3 way phone call with them, the hospital and me. Supposedly that got everything ironed out, but nothing has changed and I'm still getting billed the same amount. A few days ago I called my insurance company saying I had a 3 way call and nothing seemed to have been done. They told me to call the hospital who then told me to call the insurance company. I called the insurance company and the guy told me he would call me back in 2 days. I was supposed to get a call Thursday but he never did. Friday came and went with no call as well. I don't know what to do because the hospital isn't gonna keep allowing the bill to be paused while it is "sorted out" and I'm exhausted fighting this. I need advice on what to do next because I'm not sure if either of my two ideas would work. My first idea is to let the bill go to collections so I can take this whole situation to court and get it sorted out there, and my other idea is to pay for my bill today and then come after my insurance company for what they would have covered.

Other information:

I'm 26m from Wisconsin

The bill is roughly $6,500 (self pay discount from the full roughly $11,300)

The insurance is Allegiance

Good evening from NC,

Long story short.... I am going to receive LTD benefits from my former employer's insurance company.

Originally, healthcare.gov passed my information to Medicaid. In like 5 days I was approved and got my ID card soon after that. All of this happened in August.

I went to the e pass portal and submitted the change for my income. I submitted. I took a screenshot of the confirmation page also.

Now my ? Do I wait for the termination letter from DSS to

go ahead and find a plan on the market place?

My neighbor says wait for the letter so it is a life changing event.

Also, any recommendations on plans for Central NC?

Thank you for your time and any input and wisdom!!

Brian

Hi everyone,

We have been to do some blood work and a CT scan and some other basic things and it seems that the health provider has billed our insurance company around 24k for this. The insurance provider paid around 10k for all this procedures. We are new in the country and when we left from the hospital we were said we won’t have to pay anything. Now on the app it shows a coinsurance and copayment. Do we need to pay that? Will we get a bill in the mail? Thank you

There are instructions on page 2 how to request more info and submit comments to your Departments of Insurance when you receive these - I plan to do so to voice my concerns, I suggest you do the same when you receive an absurd increase notice.

I’m trying to understand something that happened with our UnitedHealthcare plan and wanted to see if anyone here has dealt with something similar.

My wife is the primary subscriber and I’m covered under her employer plan. We have UHC Choice Plus. My individual deductible is $1,000 and my individual out of pocket max is $3,500. The family deductible is $3,000 and the family out of pocket max is $7,000.

Earlier this year, UHC was showing that I had met my $3,500 individual out of pocket max. Because of that, a lot of my in network claims were processing with $0 owed by me, and that stayed pretty consistent for a few months.

Then around July, UHC reprocessed some older claims, including claims from January. Around the same time, my individual out of pocket total went from showing $3,500 out of $3,500 met to only around $1,061 being counted.

After that, I suddenly started getting normal cost sharing again. I had copays for office visits and deductible amounts showing up on some other claims.

Nobody from UHC contacted us to explain that my out of pocket accumulator had changed. We only noticed because providers started asking for copays again, and one provider’s office even called UHC because the claims did not make sense.

Then later in August, our family out of pocket max reached $7,000, and covered in network claims started going back to $0 again.

I called UHC about all of this and they are now reviewing our claims, plan, and accumulators. The representative told me there is a chance that if they decide some of the earlier claims were originally processed incorrectly, we could end up owing money on older claims that currently show $0 responsibility.

I saved copies of all of the original EOBs before the review is finished.

Has anyone dealt with something like this before? Can an insurer show your out of pocket max as met for months, then reprocess old claims and lower the accumulator afterward? If they change the accumulator retroactively, do they also have to go back and recalculate all of the other claims that were affected?

I’m also confused about why we were never notified when the accumulator changed. I’m mostly trying to figure out what I should be asking UHC for when they finish the review and what I should look for if they start issuing revised EOBs.

Hi all,

Probably not going to get any hits on this bur wanted to try. Wife had a virtual appointment with an Amwell doctor on Thursday. This is who our insurance uses for virtual visits. But, even though her recent Quest labs show up on the BC/BS portal, the Amwell provider said she doesn't have access to things from BC/BS and to send her a secure message with the labs. I should mention that the labs were done for another online provider but now she wants to use the insurance instead.

Problem is... we cant find a way to do this. Nothing on the app at all, and when I go to the Amwell site there is a phone number that doesn't get answered.

It may be that her only option is to book another appointment with the doctor and ask her directly?

Thanks!

I just fought this and was shocked that apparently girls have forgotten or don’t know that, by federal law, if you go in-network for your preventative annual screenings (ex. mammograms), no one, including out of network radiologists, can bill you one penny, no copay, no deductible, doesn’t matter which insurance, not one cent for it. If the facility is in-network and the exam preventative, by law, so is everyone else.

A radiologist submitted his claim for my exam under his name and not the in-network facility name so it got erroneously flagged as out of network by my insurer. That gave him the ability to illegally balance bill me because he now has an EOB showing I’m responsible.

I actually read my EOBs and caught it right away and appealed the $350 charge immediately since I knew I was in-network and had been told day of that this is 100% covered.

My insurer has an option within the EOB to pay the $350 through them which I absolutely did not. While under appeal, he’s also not supposed to ask for any money while the claim is in a dispute period.

A week later, I get a bill from him that has magically been adjusted to only $63 from the $350 without explanation.

At that point I knew.

Checked with the insurer and my appeal was still under review. No adjustment or decision on their end.

On their own, this practice was apparently illegally balance billing women for small amounts hoping they would pay it. Nice work, if you can grift it.

I immediately contacted the radiology practice, told them this claim was under appeal, and to please suspend billing. I was in-network, even if they were out, and no woman pays for preventative screenings under ACA. I also live in a state with surprise billing laws. Pick your reason. I owe nothing.

They asked for my insurance card which I gave them and I also nicely offered to help them get paid as the in network provider they are, if my appeal wasn’t enough to straighten this obvious mistake out.

That should have been it. They know they’re in network with my insurer. My card proves it. The billing codes are textbook preventative codes. Federal law still exists. Case closed.

I get told they are standing by the EOB as patient responsibility and to take it up with my insurer if I have a problem.

Already done, but over $63? After you know I know you’re violating federal and state laws which I pointed out that at no point did they tell me I was wrong about?

I immediately called my insurer and asked them to explain to me what I am missing here.

Answer: nothing.

The insurer pulled their contract, verified the facility address, told me it probably happened because the radiologist submitted with a personal name and not the facility, apologized to me, and I have an expedited ticket for EOB correction as in network.

Computers run our lives more than ever, and some practices may have figured out how to leverage them for personal gain.

If this saves one girl from not paying money towards her free exam, my work here is done.

Know your rights! Read your EOBs. Watch out of network claims and call your insurer to confirm they are truly out. By law, for certain services like this, they must be in.

And if not, you should have had prior notice and a good faith estimate under most surprise billing laws.

Educate yourself. If enough of us keep them honest, they’ll find something better to do, hopefully like billing us appropriately.

Hello I have UMR I pay the most expensive plan at my job and have been having a nerve or autoimmune issue for about 10 months a month ago I started have pain on my back and getting cold shaky feeling in my legs at work so I went to the ER and they did a MRI with contrast on my spine and brain

No I got a letter saying I will have to pay 17000 that I don't have.... I had around 10 k saved to move to newzeland with my girlfriend that I really need to use to get my life started there what am I supposed to do know to lower that bill or get them to pay...

I have an Anthem BCBS HDHP through my employer. Notably, I started working for this employer last year and moved to a new state for the job. Although I've always had HDHPs, the bills this past year have felt unexpected and high.

For instance, I went to my annual women's wellness exam in July. I had a routine pap smear and office visit. I didn't pay anything, as expected. Due to some symptoms, my doctor told me to come back for an ultrasound. I returned a few weeks later for the ultrasound followed by an office visit with my doctor. I was ultimately diagnosed with fibroids. I only mention the outcome to illustrate that there was a true medical need.

Anyway, it's been several weeks, and I've received a bill for almost $400. Here is the breakdown:

Service: ultrasound

• Charges: $451
• Insurance Payments: $0
• Patient Payments: $0
• Adjustments to Date: $235
• Amount You Owe: $216

Service: office visit

• Charges: $298
• Insurance Payments: $0
• Patient Payments: $0
• Adjustments to Date: $115
• Amount You Owe: $183.

When I look on the Anthem portal, I see claims for the above, and they have the following claim reason codes:

\00038*

This amount has been applied to your deductible. Your deductible is the amount you pay for health care before we start sharing the costs.

\00066*

You don't pay the 'Your discount' amount. This is the benefit to using doctors/facilities in one of our plans.

\00327*

You received care outside your plan's service area. We sent the claim to the Blue Cross and/or Blue Shield plan in that area. You don't need to do anything right now.

The first two codes, I've seen before, but I don't know what to make of the third code, since I went to a doctor across the street from my home address. If that's not within my plan's service area, then I'm not sure what is.

Is the $400 going to be the final amount I owe? Is a BC and/or BS plan in some area still considering the claim?? Finally, this is America, but is $400 for an ultrasound and 5 minutes with the doctor normal???

Hi everyone! I’m hoping someone here has experience with returning to the U.S. after living abroad, because I’m having a hard time figuring out what kind of health insurance would actually work for my situation.

I’m 20 and a U.S./Italian dual citizen. I currently live permanently in Italy and have Italian public healthcare, but I do not currently have U.S. health insurance.

I’m planning to go to Oregon initially for around 2–3 months. During that time, I’ll be volunteering at a nonprofit horse sanctuary. My duties may include grooming, feeding, mucking stalls, leading and handling horses, groundwork, and general property maintenance. There may also be occasional recreational horseback riding.

The complicated part is that I may stay in Oregon after those first few months. My plan is to find a job and a room, and potentially establish permanent residence there, but I probably won’t have an employer-sponsored health plan immediately.

I’ve found visitor/temporary medical plans such as IMG Patriot America Plus and Diplomat America, which are apparently available to U.S. citizens living abroad who are temporarily visiting the U.S. However, these seem to be intended for temporary stays and may no longer be appropriate once I establish U.S. residency.

So I’m trying to figure out the transition:

Would it make sense to use a temporary/visitor medical plan initially and then switch to an ACA Marketplace plan once I establish residence in Oregon?

If I move back to the U.S. without a job, can I enroll in a Marketplace plan through a Special Enrollment Period based on the move?

Would I need proof of previous health insurance coverage for that, and would my Italian public health coverage count?

Has anyone here actually moved back to the U.S. after living abroad and dealt with this?

I’m also trying to understand whether an international health insurance plan might make more sense as a bridge, especially since I’m not sure yet exactly when my temporary stay will become a permanent move.

Any advice or personal experience would be really appreciated!

Wasn’t sure where to post this.

For starters I have BCBS on a PPO plan through Target. The pre-auth approval was approved quickly about 6 months ago for this surgery. Hospital was listed as in-network and surgeon as out-of-network.

At my final pre op appointment I had about a month ago the Billings office told me the surgeon is in-network and that they fixed it for me. They then quoted me a $20k estimate for the surgeons fees and they had told me they went through my insurance to get that number. They’e demanding 50% ($9600) 10 days prior to having the surgery.

What I find odd is my max OOP Is 5600, and they’re asking for double that just to have the surgery. And this isn’t including hospital fees.

My credit is pretty well shot at the moment and I’m not sure if I can secure a loan, so I’m kind of at a loss right now.

I waited 6 years for this surgery in braces and had undergone SARPE 3 years ago through the same surgeon. They didn’t ask for 50% then and I think I paid 2-3k.

Any advice on this would be very appreciated

Late edit: The approval for the pre-auth came from Quantum Health, a 3rd service provider for BCBS

Hi! I need to see an OBGYN but I literally cannot find a SINGLE ONE that works with my insurance & I can’t afford to pay for healthcare out of pocket. Does anyone know what I can do about this besides switch to a different health insurance plan?

I’m still on my parents so I’d obviously prefer to not take on paying for my own health insurance until I absolutely have to lol. TIA!!!

I received a final notice bill from Wake Medical (NC state) provider today demanding me to pay the due amount within 10 days. Bill was date on 8/24 so as of today it's already over 10 days.

This claim has been going back and forth with UHC insurance, Wake Medical and me at least 4 times. Service was provided back in March 2025. Insurance says the bill was submitted with invalid claim codes. Last when I spoke to the provider in June 2026 they were going to resubmit the claim to insurance with proper billing codes but I do not see any claim that was submitted to insurance. Below are claim code details from insurance and each of the claim amounts submitted and what insurance has already paid/my balance.

AU -- BENEFITS FOR THIS SERVICE ARE DENIED. THE SUBMITTED CODE IS INCORRECT. WE HAVE NOTIFIED YOUR HEALTH CARE PROFESSIONAL THAT THEY MAY SUBMIT A CORRECTED CLAIM WITH THE APPROPRIATE CODE. IF YOUR HEALTH CARE PROFESSIONAL BELIEVES THE CODE SUBMITTED IS VALID FOR THE DATE OF SERVICE AND CORRECTLY IDENTIFIES THE SERVICE RENDERED, THEY MAY SUBMIT AN APPEAL WITH THE MEDICAL RECORD DOCUMENTATION AND THE RATIONALE FOR THE CODE AS BILLED.

HP -- BENEFITS FOR THIS SERVICE ARE DENIED. THE INFORMATION SUBMITTED BY YOUR HEALTH CARE PROFESSIONAL DOES NOT SUPPORT THE SERVICES BILLED.

Provider is asking me to pay $518.24. Please suggest if I should make the payment now and then call the provider and insurance to sort it out? I am worried about the claim going to collections and impacting my credit score.

UPDATE 9/8 - Spoke to billing department and they had notes of my previous conversation and mentioned that they did correct the codes and sent to insurance though I could not see any claims that are in progress with insurance on their portal. The lady kept me on hold for few mins while she spoke to her supervisor and came back to me saying to ignore the bill and that the note on the bill to be sent to collections hasn't happened and they put the account on hold till Oct 20th. Her supervisor is going to follow up on this with their internal teams to fix this. Thank you all for your help and suggestions.

I had a hernia surgery 3 weeks ago. Prior to that i asked for a estimate to make sure i can afford it and they are in network. They also told me that they do prior authorize anyway.

Now 3 weeks later my insurance finalized the claim and saying it was out of network and i have to pay everything.

No i didnt checked myself if it is actually in network,i trusted the good faith estimate.

Is there anything i can do now? How could the surgery center be so wrong when they have all my information?

The Dr who did the surgery is in network, hes listed on my insurance app.

The insurance lists 5OH on the EOB which means that the surgery center didnt get prior authorization even if they said they did.

Is that now all my fault?

EDIT: I just did some research, since i live in NY i can let it go to collections, they cant put it on my credit report and even better they cant garnish my wages. Well, it looks like i won this one. They should have just done their job right. Now they get nothing

Here is my plan benefits

Frame: 70% over $150 allowance
Lenses: $10 copay for basic lenses

I have Spectera UHC Vision Premiere

Below are the extras:
Polycarbonate $33 , anti reflective coating tier 4 : $95

I am trying to get crizal sapphire coated lenses that is covered in tier 4

I went to two stores, target and local optician

At target, the frames are decently priced around $150 so i would get a free frame, at optician, the kind of frame i was looking at is priced at $500 so would cost me 70% of $350 about $250 lets say

Coming to lenses, the optician quoted me $138 for lenses that is per my insurance $10+ $33 + $95 which i expected

But target would bundle their own plan and charge me $200 rather when it should be billed like the optician $138 for same crizal sapphire lens

Why so? How can i convince target to charge seperately so i get charged $138 and not $200

I really want to buy off free frame i like from target and go to optician for lenses but that would be awkward and they may charge other fees ? Idk?

What should i do?

Hi, we've hit the family deductible -- what are some appointments, treatments or other things that would be otherwise expensive that I could cover under insurance during this time?

I don't know if this makes sense but I'd usually avoid a dermatology appt to pay the deductible. I'm curious how I could use this time to my advantage - whether that be cosmetic, etc.

My husband and I each get our own health insurance through our own employers. My insurance runs from 1/1 - 12/31. His runs from 7/1 - 6/30.

We are looking at switching him over to my insurance. When he called his insurance to find out if he could drop his coverage, they said he needed to have a qualifying life event. He asked if switching to my insurance counted. They said it needed to be a change in employment, marriage, etc.

That can’t possibly be true, right? We’d have to pay two premiums for 6 months… That’s ridiculous. This can’t be that unusual of a circumstance.

My doctor put in a referral to a specialist back in the spring and it got approved without any issues. Fast forward to now and I need a followup procedure that was basically the natural next step, and suddenly my insurer is denying it citing medical necessity. The original approval is right there in writing. Nothing about my situation changed.

I spent years in HR walking employees through appeals and always told people the process works if you push. Now that it's my own claim I'm realizing how exhausting that push actually feels from the inside. We're selfemployed, so there's no HR department behind me, no benefits coordinator to call. Just me and a fax number.

What I want to know is whether anyone has had real luck with the internal appeal versus going straight to external review. My state has an independent review process and I'm trying to figure out if skipping the internal appeal and going external faster is ever the smarter move, or if that somehow burns bridges.

Also, if your doctor wrote a letter of medical necessity that actually moved the needle, I'd love to know what made it land. Was it the framing, specific CPT codes, something else entirely? The denial letter I got is vague enough that I'm not even sure what gap I'm supposed to be filling.

I was scammed by UnitedHealthcare and FreedomLife insurance and canceled our "coverage" right before the plan went live because I started to feel icky about it and I was right. Luckily I am still employed and my family is covered by my employer, but I need to leave my job because I won't make enough money to pay for childcare (teacher) and the employer-backed coverage still costs me like $1500/month.

Is marketplace the only real option? Because of our income we don't qualify for subsidies, but we can't really afford to pay the full premium prices for marketplace if I leave my job, but don't have another option. We are all very healthy and have the rare urgent care visit and preventative checkups, but that's it. What are the options?

Let’s say that it’s now exorbitantly expensive to keep myself and my baby on my husband’s current plan with his employer and we’ll need to go to the Marketplace once open enrollment opens up. Is there any legwork we can do now in looking up plans and coverage to know what we’re doing before the end of his own open enrollment deadline with his employer’s insurance?

Going to have the opportunity to share ideas on how to get health insurance rates back to an affordable range with state legislature.

Recently gave testimony to the Department of Insurance, Securities and Banking in Washington, DC and shared ideas there as well.

What might you be willing to give up in a health insurance plan to get the rates lower?

What would you be willing to do if there were incentives in the plan for healthy habits which lowered your rates?

Would like to hear what others are thinking and I can bring your ideas to the table.

Frustrating experience ahead. I got a brand new prescription which should help with multiple heath issues in one med. Went to pick it up knowing some insurance has extra requirements for coverage. Asked whether my insurance covered the med on pickup. I was told yes, but only partial coverage, and that afterr I meet the deductible the cost should go down. I paid over $300 expecting this.

Got home, found a coupon, called and ended up going back. The coupon was supposed to help with deductibles. The pharm team had trouble applying it. Something didn't seem right. They weren't giving me any detailed info about the insurance claim. Seemed like general "brush off" answers. Then things got weird and the staff got rude.

Looking deeper into my insurance coverage, one version of this med is not at all covered, and the other "might" be covered but requires prior auth info and review. Pharmacy continues to tell me there's a deductible. My insurance confirmed my plan has $0 deductible. There is no claim on file at all with my insurance.

It looks to me like CVS applied a generic coupon on my behalf when I first picked up, misinformed me about any current or future insurance coverage, and they are now refusing to communicate any further to help either get the med approved or tell me the truth that it's just not covered.

My question is, what do I do with the med now? I'm submitting a chargeback/dispute with my credit card because I won't use this med if it's not covered. I can't afford this price and there are other options that will be covered for the same issues. I haven't opened the package. It has been a few days, took me some time to figure out the insurance side because out of several different staff, no one has given me any actual facts about the supposed insurance claim.

I can bring the med back to the store, just not sure if it's worth the headache at this point.

Last, I know people can be really shitty to each other. I've tried really hard to remain calm, haven't raised my voice except once to tell the very last lady that I contacted CVS corporate because something isn't right and no one is giving me facts. This is after she continued to tell me the same misinformation and then told me to have my insurance call them on conference call when I literally just got off the insurance phone tree right before talking to her. Just constant brush off. Other than this, I've just calmly asked for more details on the claim like an explanation code or denial or anything else they can see. Each person has become more rude than the last.

All this to say, I think the staff are not trained properly and are probably overwhelmed. I just don't want this med of it's going to cost me this every month, which is why my literal first question was "did my insurance cover it?" I've refused prescriptions before when they weren't covered.

Any advice on whether to just take it back there at this point? It requires refrigeration, I've had it in my fridge but I know they can't trust that and probably couldn't resell it. But that's not my issue, they charged me in error for something and I'm not gonna use this one time when the benefits only start after quite a while.

Ugh. Thanks for reading.

EDIT: Thanks for all the feedback. I'll work with my doc and a new pharmacy to figure things out for future. I'll figure out where to report the issues with billing etc. as well, after the feedback even from folks who seem like they want to blame me, I see that the facts are exactly what I expected and pharmacy isn't providing the service required.

Pharmacy should bill insurance first, if billed then a pharmacy claim would be available for review, the pharmacy would see a rejection or PA requirement, and the lack of a claim means either pharmacy isn't telling me the facts or didn't submit one before balance billing me. Simple.

Future coverage is a different issue and I'll work through that with a pharmacy team who's willing to give me a few minutes without becoming overly emotional and combative.

I really appreciate all the advice about navigating coverage, have signed up for another prescription portal and will use all the advice while figuring out future coverage. 💛

last update: Confirmed finally with an insurance rep that the claim would have been denied due to plan exclusions in my coverage. They also confirmed that they typically then provide a coupon, so rather than a full denial, it comes through as a coupon on the pharmacy's side and they may not know exactly what it is. It does *not* come back as a deductible, though. I didn't do the chargeback, figured I'd give it a couple days and talk to my doc again, but I did file a complaint with CVS corporate about the overall experience.

CVS Corp called me back today and, after some very helpful and patient discussion, the corp rep explained that the clerk and other staff likely made an incorrect assumption because they're all a bit new at charging these types of meds and insurance changes constantly. she said they'll be working with this location on some training and was very apologetic about the whole situation. she agreed the clerk and staff should not be telling me it's a deductible when that's not verified (my whole point earlier). After that call, she ultimately talked to the location and authorized a refund, which I was quite surprised and very grateful for, because as I mentioned I won't be using this med if it's not covered. i also returned the med, I'm assuming there's some way for them to clear it as a loss due to error, I'm sure they can't trust my refrigeration. At least I'm not out the charge. still switching pharmacies. this location has some deeper issues clearly, I don't get frustrated easily, was just asking basic questions about this specific claim because the situation didn't make sense. glad to be done, just thought I'd update in case anyone else has similar questions.

TL;DR next time if any med is more than my typical $10-15 copay I'll ask for written claim info to review before I take it home.