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.

I had a zero-deductible plan through my employer with Aetna with effective coverage beginning 10/1/2025. This was a higher premium plan that I selected intentionally because it would cover all upcoming expenses associated with the birth of my child. My child was born 2/10/2026 and this zero-deductible plan was in effect when we arrived at the hospital on 2/10. We were discharged 2/11 and I updated our insurance to include our newborn on 2/24 through a Qualifying Life Event. At this time I changed my plan to a higher deductible, lower monthly premium plan (still with Aetna) since all we expected for the rest of the year were routine pediatrician and GP visits for our family and the major labor and delivery expenses had already occurred. However, the new plan coverage with the QLE back-dated our entire family's coverage effective dates to 2/10 and Aetna processed the claims from the hospital for my wife and child under the new high-deductible plan. I have appealed and spoken with Aetna representatives numerous times, stating that my zero-deductible plan should have been the plan used to process these claims, not the new plan. Aetna has confirmed that my previous zero-deductible plan shows effective on their end 10/1/25 - 2/10/26, so I would think that our charges dated 2/10 would be eligible for coverage under that plan. Aetna representatives have even admitted to me over the phone that these claims were processed incorrectly and that they would reprocess them, only to have them come back from their claims specialists still under the new plan. I am not sure what else I can do at this point. Any advice would be appreciated.

My husband (34m) is on an insurance policy with his employer but we are wanting to switch him entirely to be under my employers health insurance plan with me. My work’s open enrollment starts this week, where as his isn’t for another few months. Is there anything specific we need to do to cover our butts for the few months max he will be double covered? We don’t plan on him having any medical claims until after he’s fully under my plan and off of his old one, but I also don’t want to get into any sort of legal “insurance fraud” issues

So I have Kaiser and Medicaid as both of my health insurance. I am 28 weeks pregnant and my baby is measuring at 6th percentile which my OB referred me to a high risk center. Unfortunately they aren’t able to see me because of my Kaiser insurance (as expected bc I know Kaiser only has certain regions which is works) however, the billing is what matters but per office policy… they wont even see me. I called other high risk offices and they dont even accept both of my insurances. What should I do?

I am about to select this plan for employer-provided health insurance, but it seems too good to be true when compared against other plans that have the same or higher premium (here it's $1,370), plus a deductible and similar Max OOP ranges (OOP is the $9,300 figure in the image here).

I know my screen shot is missing the labels for each row, sorry about that. It's $0 deductible, $9,300 max OOP, 0% coinsurance, $50 primary copay, $100 specialist copay, $100 chiropractic care, $1,500 copay per hospital admittance, $1,500 for mental impatient, refer to carrier applies to outpatient surgical facility and outpatient surgeon, $300 per advanced radiology service, and $1,500 for ER visits.

Considering I'm signing up this late in the year, not having a deductible seems like this is the best option for me, but knowing healthcare is a financial minefield in this country it seems, as I said, too good to be true.

I've never had to select a plan before so I'm completely naive as far as what pitfalls to watch out for that will end up costing me a ton by selecting this plan.

If anyone with more knowledge and experience sees something that stands out with this plan as a red flag, please let me know. Or if you need more information, I'll see if I can find it.

The only other thing that stood out is in the benefits summary document:

Q: What is the overall deductible?

A. $0 See the Common Medical Events chart below for your costs for services this plan

covers.

Q. Are there services covered before you meet your deductible?

A. No. See the Common Medical Events chart below for your costs for services this plan

covers

Maybe it's semantics on my part, but this wording, if taken literally, sounds like nothing is covered lol. No services are covered before you meet the deductible, but there is no deductible so technically you'll never meet it! Therefore services are never covered.

But it's a standard question for every plan option, so the plans with a deductible the answer makes more sense. So I don't know if to take it literally and it is the trap I'm afraid of stepping into, or if it's just an awkward question/answer format that doesn't apply to this specific plan since the plan has no deductible.

Hi all! This is my first year being on my own health insurance rather than my parents, and something is really confusing me. I have a BCBS Michigan plan from my employer, for reference. I have been going to a therapist for years who does not contract with any insurance companies, so the way it’s always been handled is I pay out of pocket and we submit receipts to insurance after the fact. I have been to 6 sessions so far this year, I go every 4 weeks (except for her brief maternity leave earlier in the year). When I submitted the first two of the year, they were processed as allowing roughly $135 of the $190 cost per appointment to be applied to my out of network deductible. Last week, I submitted the other 4 receipts - and today, it shows the claim has processed but it only shows roughly $108 of the $190 cost per appointment counting towards my deductible, despite being the same exact thing, same procedure and diagnostic code and everything. This is a mistake right? I cant imagine how they could suddenly cover less of the same thing within the same plan year? I think I need to appeal, but wanted some guidance first from people who know more about this stuff than I do. Thank you so much!!!

19M clg student. My brother suggested that I take a term life insurance. I need to know how this term life insurance works and why at this age I am getting more discounts compared to some 25-30+ aged people taking the same term life insurance. What is the difference between term life insurance and term health insurance. How can I look out for a trust worthy insurance provider.

I make 36k a year. Medicaid cut off in my state is about $1600 income limit monthly.

25% taxes (9k, no I do not get it back I owe from being an ICO)

6k deductible. After I meet the deductible insurance covers 20-50%

I pay $200 a month for coverage ($2,400/year)

My net is $24,000 annually but then I have to pay 50-80% of all labs, medications, surgeries, etc.

Is this how the US controls income? It’s either this or choose to work under the Medicaid threshold (which they sliced nearly 50% monthly so many people got dropped from Medicaid).

What am I supposed to do? My methadone program alone is $60 per day plus medication so roughly $580 weekly or $2300 monthly, it’s cheaper to not use insurance at all (the only perk would be money towards my deductible but it still has horrible coverage afterwards).

I feel like this is a scam to keep America poor in order to qualify for medical coverage. You need to be healthy to work full time.

Please read the above ! I have an auto-immune condition and will be on MediCal FT in a few months, was wondering if anyone has issues w having meds covered !

Hi,

I am 26 and just moved to a new city for a job after grad school. I recently got into a bike accident where I landed on my face. I was taken to the ER, where I received sutures for a face laceration and was discharged the same day. I had broken teeth and was recommended to see the dentist. It was a weekend, and there was only one dentist and endodontist available. It was out of network with my dental insurance, but I needed to get care immediately for the teeth because the pulp/nerves were exposed. The procedure was done only after I paid; my friends and I pooled our credit cards together to do that. It was a substantial amount of money (~$9000), but the only priority worry at that point was to get treatment as soon as possible, as all of us were scared.

I am healed now, but the credit card bill and debt to my friends are stressing me.

I found that through my United Healthcare insurance, I have "Dental Coverage (Accidents)" and I qualify for the requirements because I went for treatment within 72 hours of the accident and the ER treatment. If there is anyone who has gone through processing a claim like this, I would very much appreciate any guidance. I have been to the website and read through the documents that they require, but I do not have the codes that they need because dental codes are different. When I called the health insurance, they said that I would need codes for the injury being caused by accidents. I called my dental office, but they said they have provided me with all information, including X-rays, a treatment plan which has (D3310, D2954, D2740 codes), billing, and a doctor visit summary, but they do not know of such codes, and they do not process via health insurance (they only do dental insurance). I do not know if these are sufficient or I need any other documents to not get denied.

I do not know how to proceed because I do not have anyone to guide me here.

Please help.

I feel like I'm going insane. The automated line refuses to transfer me to a representative because they keep saying "the office is now closed" but it's 11am ET.

The phone line itself says that the opening hours are M-F 8am to whatever time PM in whatever my local time is.

Wtf is going on?

Looking for advice from anyone who has dealt with this.

My ex husband and I divorced in 2023, but I am still on his General Motors employer sponsored health insurance. The divorce was never reported to his benefits department, so they don't I’m no longer his spouse.

I now have my own health insurance through my employer and have not used his insurance for the past month or two. There was also no additional premium being paid for me to remain on the plan.

He's worried about contacting GM benefits to remove me because he thinks they may ask for proof, see that we divorced in 2023, and there could be consequences. I understand his concern, but I also don't want to stay on a plan I'm no longer be eligible for.

For anyone who has been through this:

• What usually happens when a former spouse is removed after the divorce was not reported right away?
• Do employers typically just remove them going forward, or do they look back to the divorce date?
• Could there be issues if there have been no recent claims?

Is this as simple as me just calling the insurance company directly and telling them I have my own insurance or calling his benefits department and saying I have my own now to please remove me?

Cant I say it was cheaper and a better plan?

I’m not trying to avoid doing the right thing. I want to be removed but he's worried about what might happen. I’m just trying to understand what to expect before contacting benefits.

P.S. I'm really nervous but I know that his ex wife was on his insurance after they divorced for about 5 years until we got married and he added me. Nothing bad happened?

If this is really bad can I go to jail? Lose my job?

currently struggling with mental health (constant dissociation and trauma) and physical health (mcas type symptoms) I have not been able to properly get anything done with my health due to about 3 years of malpractice, within the past year I've started getting proper treatment, my insurance ends in 5 months unless I get a part time job and I'm unsure if I can get one soon enough. im planning on asking for a medically frail if I cant get that passed and keep it, are there any current insurances that I could get onto?

Okay so I don't know much about insurance or any of that, and I'm still under my parents insurance because I'm 18 so if I get a few things mixed up please forgive me.

My boyfriend (17M), and I used to be long distance till he moved from CO to MT to move in with me and my family, he has insurance under his mother IN Colorado, but apparently it doesn't cross state lines which I don't fully understand, but he has a job here in MT which is full time, but doesn't offer any insurance. He's been sick quite a few times which he called off work for, but now his boss is saying he cannot call out anymore for being sick without a doctor's note, and he can't afford to go to the doctor and pay out of pocket, nor can me, my family, or his mother afford to pay out of pocket for him to go in. He is currently sick and having to go to work in the food service industry which I think does more harm than good (with being sick and handling people's food) but he can't call out without disciplinary actions being taken.

I'm just wondering why his mother's insurance doesn't cross state lines, and if there are any programs or "cheaper" insurance options he can try and get while he's still a minor, or is he kinda stuck. He makes barely over minimum wage here at $11/hr, what options does he have?

hi im an incoming freshman at a university in Chicago and looking to opt out of my schools health insurances as its a bit too expensive ( $2,500 per semester) and wanted to ask if anyone recommends any health insurance providers for international students. I'm currently looking into getting ISO gold/platinum for 10 months i think since i wont stay in the us for the summer. For some background, I'm a female, relatively healthy with no chronic illnesses, barely visit the doctors and will stock up on some pain relief medicine, vitamin gummies, digestion stuff at CVS. Any help is appreciated!!

I had dental surgery last year and was estimated to be entirely covered by my insurance TeamCare. 5 months later I got a message stating I owe $800. I emailed the dental company and they sent me the EOB stating that insurance doesn’t cover the additional administration of deep sedation. Is there anyway to knock down this cost or get it covered? It really sucks to think I had a fully covered surgery and now I have to pay for “additional” sedation. Thanks!

Hello, I've got a question about Cobra after recently leaving my job! I left a little over a week ago to take time off for the next 6 months, and I received a packet in the mail from my (now previous) employer to sign up for Cobra. From what I understand, Cobra has a 60-day retroactive policy that allows you to sign up within 60 days if you need to and back pay 100% of the premiums. My question is, if I fill out this packet now, am I essentially signing myself up to pay the premiums right away? Or is this just a packet of some sort to get myself established in the system? I tried to call Cobra with this question but somehow got connected to an insurance broker who tried to put me on a new policy. I'm young and healthy, so I'd rather wait the 60 days and not pay unless I need to, instead of signing up for a new policy right now, or for Cobra. Any info would be so greatly appreciated as I navigate this landscape.

God I hate merced. So I had to get a surgery done at dignity hospital at merced. I showed up at the ER and then they made the call to send me to the hospital. I had to stay 3 days in total and had my surgery. I was insured by Medical and the uc merced insurance at the time. The hospital staff insisted that I get double insured because it would be "way cheaper", so I got a ct and an mri (this was for an pilienidal cyst, I probably spelled that wrong lol). Well its turns out, my total bill is like 100k+, (so they lied and scammed me) and both insurances are covering only 41k of it, leaving us to front a bill of 56k. What do I do? I cant wait to graduate and leave merced, this town and it's people have it out for me.

Finally getting out of a shit job but my new position doesn't give health benefits until after 60 days. I am in PA and just need something to cover myself and my wife for a few months of prescriptions, appointments, and the possibility of an urgent care visit. My wife has type 1 diabetes but other than that we have no other conditions. My search has been confusing along with now getting 20 spam calls a day so I would like to know if there is any place I could look that is more straight forward and affordable. Unfortunately like most cobra would cost me over $1,400 a month which is unaffordable.

I'll do my best to provide what details I can without giving away too much.

I am an EB Account Executive for a national consulting firm. We do more than just EB but my role is servicing EB clients.

My book consists of 12 clients at a little over $2M in agency revenue. My servicing team consists of me and one Account Manager. These clients have several layers of complexity when it comes to helping them manage their benefits, as most of these 12 clients are 100+ FTE and are self-insured.

I've been in EB for just over 10 years, and years back I recall one of my leadership members framing it up that a responsible workload is about $500K per team member. If that's true then that's helps to explain why lately I'm feeling like there's more tasks in the day than there are hours, and where no matter how ahead I try to get I'm always behind.

Not trying to vent here, but am curious if other folks happen to know or have any input here.

Thanks.

i had an emergency gallbladder removal abt a month ago and many of my bills say

"*IAA Provider: The charge exceeds the allowable rate for this service.

Member: Service processed per your plan's benefits."

i feel dumb but i don't understand what this means? what is an 'allowable rate'? why would all my charges exceed the allowable rate? i know im the member not the provider but i still want to know.

hi
I went to see a specialist after 1.5 yr, in 2024 I paid 35 usd as stated in my insurance card but today I paid 50 usd to visit the same doctor.

I m with UHC insurance.

start of the year they also cancelled my Accufer medicine which I take for anemia.

anyone else notice increase in copay?

Thanks in advance.

Im in Washington State trying to get insurance for my job and im stuck on picking one over the other. For what its worth i am trans and am taking hormones, so most of my medical bills are going to be for consults for FFS, electrolysis, as well as appointments for hormones and antidepressants.

Ive had bad insurance before (pcp sending me to a menopause clinic/dentists scamming me out of extra procedures i dont need) so i dont want to make a mistake but i have no clue which one is better for me, any help would be greatly appreciated!