So as the title suggests, my husband needed an ambilance a couple of weeks ago, and the ambulance company just sent us a bill (for around $2000) that was not sent to insurance for consideration at all.

I understand that the ambulance is out of network for my insurance, but my insurance should still cover it as it lead to hospitalization and the plan covers out of network ambulance at billed charges.

My question is, what is the right procedure to loop in insurance? Should I pay the bill out of pocket and submit a claim for reimbursement (which I think would also require asking the ambulance company for an itemized bill with all the info the insurance claim requires as the bill they sent me is pretty basic), or should I request the ambulance company bill insurance directly?

They only give 30 days to pay before I am guessing the bill would be sent to collections so want to make sure we get the process right.

Thank you for your guidance!

Hi, first time poster here. Sorry if this has been covered.

At the deadline last night, I did enough of my taxes to realized I'd qualify for Medicaid- I'd been on the essential plan prior. (I've had NYS medicaid before). I Enrolled (and switched from Anthem to Healthfirst on some advice), and everything seemed ok. Nothing in the application at all suggested that I'd be without coverage for a month.

Well, as you can guess- today, I got the disenrollment/enrollemnt notices. I figured my essential plan would end Feb 28, but nope. Ended jan 31. Do I really just not have health insurance this month? I wouldnt have reapplied if I knew this could happen. It's a weekend so both NYS of Health and both insurance offices are closed. This would literally ruin my life if this is the case lol. Do I have any recourse at all at this point?

Hi everyone,

Please help with advice. Im a 31 year old female who randomly came down with severe pneumonia in August and had to be hospitalized. I went to a hospital that is in network with my insurance. I had severe fevers and symptoms and during this time MANY doctors would just randomly come into the room to ask questions and check me.

Fast forward to January, I am being billed 4500 and listed with 3 different visits by the same doctor. This claim was denied and the reason stated is - "The patient's coverage only provides for this service when performed by a Network Provider. Therefore, no payment can be made".

I wasn't in control of who came into my room or who came to see me at this time.

Is this bill able to be fought? if so, what can I do? Theres also a few other charges from the hospital, but those at least are partially covered.

My insurance is Amerihealth.

IHC Silver EPO AmeriHealth Hospital Advantage $50/$75

I recently cancelled it as I cannot keep up with the $400 a month payments.

I (F22) had fainted out of the blue 2 months back in New York City and was taken to the hospital in an ambulance. I'm currently a student and attending college in Ohio. Because my permanent address is in New York City, the health insurance (Fidelis Care) sent my medical letters to the permanent address, and denied me.

I don't know what to do, especially the appeal process will end on; March, 29th, 2025. Thank you.

Edit: I make so little money that it ended up being close to zero on the tax papers (part-timer at my college; minimum of 11-ish$.)

My UHC insurance through my employer in effective as of today, but when I try to create an account with my SSN, it’s not working it says “user not eligible”. I’m only in a hurry because my heart rate has been really fast for the past week, and I’ve been having bad headaches. I want to get checked out ASAP. If I go to a doctor today, can I submit a claim for reimbursement later once my account issue is resolved? Has anyone dealt with this before? Any advice would be appreciated!

Recently visited a dermatologist for eczema, and I made sure to call around and ask for prices in order to get the best price possible. I got a quote for $60, and they asked if I wanted to prepay. I said no and they said I could pay after the appointment. Few weeks after the appointment I got a bill for $400. Is there anything I could do? My provider was in network as well.

He really needs meds but unfortunately missed the cutoff for open enrollment last night. Going another year without treatment would be a potentially life-altering disaster for him. He has had bad experiences getting treated in the past (put in a facility involuntarily, refused the meds he was given) and it took me a long time even persuading him to seek treatment, so he will need a sure hand. He is largely estranged from his family and I seem to be the only one helping him with this (from the opposite coast, doing what I can). Frankly I am also looking for a reliable doctor to help guide him back to reality, which I can’t do alone.

Any thoughts on what some options could be? What comes to mind are:

1. There is a free psychiatric clinic in LA (where he lives) but the reviews are atrocious. Given his bad experiences with medical treatment in the past I am reluctant to jeopardize progress with a crummy clinic.

2. Looks like Covered California has a “special enrollment” period with certain criteria. Is this pretty restrictive or is it easy to get into?

3. Medi-cal also seems to be an option—not sure if he meets income cutoff though and smaller selection of doctors.

4. Paying out of pocket is technically an option, though seems prohibitively expensive.

5. Is there any other way to acquire affordable insurance/care outside of the open enrollment period?

Very bummed he missed the open enrollment but don’t want to give up hope for helping him.

I recently requested help to get a removed application reinstated. I have all information for them. And it only happened a few days ago.

They should be able to recover it, right?

I'm looking for some clarification of my health insurance plan. In the plan documents I found a clause that confuses me, "Self-employed persons, including partners and more than 2% shareholders in a Subchapter S corporation are not eligible for coverage under the HRA.".

My wife is a dependent on my plan. I'm w-2 and she's 1099 doing work for unrelated clients. Does this mean that any medical care she gets under the plan is not eligible for HRA reimbursment or is that clause only for the main policy holder?

I’m self-employed, and it’s just my spouse and me on the payroll. We're looking for affordable health insurance for our family of four. The oldest applicant is a 44-year-old male. We don’t smoke, drink, have any pre-existing conditions, and pregnancy is not a consideration.

Last year, we tried an ACA plan but ended up paying around $1,000 per month without using it once (which, in a way, is a good thing).

Since we’re not Christians, we can’t participate in faith-based health ministries, nor do we want to misrepresent ourselves.

I’m sure others are in a similar situation—I'd love to hear what has worked for you without having to pay extremely high premiums.

In September 2023, wife started working at her new job, which at the time did not yet provide health insurance. At the end of 2023, we enrolled for the new year, adjusting the estimated income and setting it at $48,000. By the end of the year, my wife earned $24,000, and I earned $4,000 (as I was absent for almost the entire year).

Recently, I found out that at the end of 2023, after her probation period, her job did offer her insurance, which she simply declined. However, according to the rules, even if insurance is offered, it automatically makes a person ineligible for a subsidy, as her insurance was considered affordable under ACA. Technically, I was eligible for a subsidy, but since we had a joint plan, the calculation applied similarly.

The question is, what should we do now and how do we resolve this situation? We have already received Form 1095-A, which shows that a total of $7,000 was spent on insurance throughout the year. Will we have to repay the entire amount, and how should we proceed with this? Do we need to file Form 8962?

Hello, I am a speech pathologist at a skilled nursing facility in North Carolina. One of my patients is an older lady whose muscles, for an unknown reason, have gotten progressively stiff. She can no longer move at all, or communicate. Someone has to feed her, get her ready, push her in a wheelchair etc. she tries to speak, but it is extremely unintelligible and can maybe say one unintelligible word per minute. She wants to communicate, her cognitive abilities have not been affected at all, just her stiff muscles are limiting her.

The one thing that she could use to communicate her wants/needs is an eye gaze device (an iPad with words/symbols that tracts where your eyes go so you can click on the words) was denied by her insurance because she lives at a Skilled Nursing Facility (SNF). The SNF does take care of her physical needs, but everyone deserves the right to speak and share their own ideas, she should not be ineligible for this device solely based off of her location of living. The denial feels unethical? Without insurance, it costs around $8000. She doesn’t have family or friends to advocate for her. And I am at a loss for how to help her. Does anyone have thought or suggestions on how I can help my patient?

Thank you.

My wife and I both lost our jobs 12/31 so we are zero income, but we have a nice savings.

Have been trying to get plan pricing on healthcare.gov with whatever savings is rightfully available to us.

Healthcare.gov keeps pushing us to state Medicaid (no income last month) but we don't qualify (too much savings)

We're down to 2 weeks to exercise our COBRA, but simply want to see what healthcare.gov might cost with whatever standard subsidies. Our state medicaid takes MUCH more than 2 weeks to make decisions, so we can't wait for their "slow no" because we'd then lose our COBRA option (and we don't know if COBRA is better than healthcare.gov or not.

Welcoming any thoughts or suggestions!

Just got a salpingectomy and endo excision done so met my max OOP. Have a physical scheduled with all the lab work and a sleep study scheduled. What else?? I have 4 months. Considering doing a hysterectomy now that I have the stage 3 endo diagnosis as well

I just received a $1900 bill from Quest because my insurance (Anthem Blue Cross PPO CA) denied their claim. I just checked and Quest is in-network with my insurance so I spoke to my insurance and they said that the bill was denied because Quest billed as an independent lab and they will only cover inpatient or outpatient lab testing. I can’t call Quest today because it’s a weekend.

I just wanted to get some advice, is the billing situation due to how my doctor ordered the labs? Or is this a Quest issue?

I’ve never had any issue with labs before until now because my insurance decided to opt out of independent lab testing starting 2025 (which I didn’t know about).

So I switched my insurance plan to start today, but when I went to look at covered California, it still says “pending.” Is this because it’s a weekend or what’s going on? I know I qualify for CC, I’ve been on it the last 4 years. Only thing that’s different is I had to switch insurance because my previous plan was no longer being covered by my doctor and I didn’t want to switch.

I have the enhanced silver plan with APTC and don’t pay anything monthly, so I didn’t need to pay a premium to enroll.

I work in medical billing. I miss Navinet fiercely. Customer service is almost non-existent within Availity. I am beyond annoyed with the BS. I have been trying to access the Walmart BCBS benefits on the site for weeks. I contacted “provider services”, submitted my ticket that takes a half hour to fill out, to be told it was fixed and it’s still not. Every time they respond, they close the ticket and I have to go reopen it and tell them again, it still doesn’t work. Anyone else have this problem?? How did you get resolution? I’m tired of playing with these people. I already called in and got the benefits for the patients cause I was tired of waiting for them, but for the future, is there a trick to this or something I’m missing that these dumbasses haven’t told me yet? TIA

I make just barely over the maximum, but enough that I clearly do not qualify for Medi-cal anymore. TBH, I didn't even realize I had medi-cal after adjusting my income once before back in like June 2024, but I somehow never got around to applying for marketplace (covered california) insurance.

Fast forward to today, a Saturday. I called my HHS case worker on Monday, she told me that she would expedite processing of my new income adjustment, and also told me something about "10 days..." and how somehow that meant I couldn't get insurance until the end of February? I guess the idea is that the medi-cal will continue to the end of the month, and then I'll be able to apply for marketplace insurance or something.

The problem with this is that I never got a little black and white provider card (I do have my BIC), and I have no idea who or what my medi-cal assigned provider is. I also don't really know if I am covered... and I have a fever likely related to a bacterial infection. Low fever, 100.2, but enough to make me feel terrible, and obviously I want to get a likely infection treated ASAP. I do not want to go to the ER, I'm more likely to get another disease that way, or at least that's what I believe. ERs are for serious injuries/illnesses, not for getting antibiotics. Plus they're very expensive if you don't have insurance, and I don't actually know if I'm covered!

To top it all off, as I mentioned, it's a Saturday. I cannot call or go in to meet with my HHS case worker, they only operate M-F, and trying to contact anyone on CC or BenefitsCal just redirects me to contacting my case worker. So... what do I do? I already did an online order of amoxicillin, but I don't know if I actually have a bacterial infection (I have an oral abcess that I've had for 9 years off and on, never ever gave me a fever before), and not 100% sure the amoxicillin is the right antibiotic, but I felt like I had to do something.

Even in a super liberal state like CA, it feels like the system is designed to actively discriminate against the very people it's supposed to help the most, those of us with low incomes. Normally I wouldn't turn to Reddit for something like this, but I don't know where else to turn. Any help would be appreciated.

Hi There,

Based on research I am in a shitty situation and am looking for help if anyone is so kind to provide advice. I quit my job in October to find something new, went on Cobra, and just realized my autopayment was not turned on. So I missed the 30 day grace period (as of yesterday) and believe my coverage has been terminated. I've been working on a contract basis so there aren't benefits.

From my understanding, I'm outside open enrollment, don't have a qualifying life event because it's a loss of coverage due to non-payment, and apparently wouldn't qualify for Medicaid because I'm too financially secure. If that is all correct, then if I get a new full time job that offers health insurance, I won't be able to enroll until open enrollment in the fall? So basically I am uninsurable until then? Kind of freaking out and don't know what to do.

Age - 28, Income - $3-5K/month, Assets - $100K I only list this because Automod says to and it might be helpful context relative to Medicaid

Hello,

Can I request the Ambetter cancelation emails from my broker as I told her to cancel the plan and she did? Wouldn't she receive the emails?

Went through an endoscopy last year and didn’t receive any bill. I was under the impression that insurance covered everything and didn’t check the Aetna website for claims update.

However, i randomly checked the Aetna website today and saw two denied claims. The facility claim and dr claim were covered, but the anesthesia claims were denied due to untimely filing. Anesthesia claims were processed as in network and the anesthesia associate was also listed as in network provider on the Aetna website.

Timeline:

April - endoscopy

August - first anesthesia claim, denied due to untimely filing

November - another anesthesia claim to appeal the previous denial. Denied again

So far I still haven’t received any bill and am wondering if I need to worry about it. Nothing owned yet according to EoBs.

I get free health insurance with covered california, and my permanent resident card expires soon, I'm in the process of renewing it but it might take a while. I was wondering if I dont get it renewed, will I lose my Covered California? I'm not a conditional permanent resident, i have a regular permanent resident card, so I still have my permanent resident status, my card/physical proof is just going to be expired, and I know once I renew, I'll get a receipt that I can use as proof, but I'm wondering if I dont get it in time, will I lose my coverage? My healthcare provider again is Covered California/L.A. Care.

I got two of them.

One telling me that my medication is now subject to a prior authorization so (insert translation here: corporate jargon for "go f*** yourself" but in a confusing, underhanded way). This is even though I did go through that process in the past.

The second, and nastier letter began like "hi, PuffyHusky! We care a lot about your health! That is why we periodically review our medication lists. The medications in the back are now moved from tier 2 to tier 6. Switch to a generic or pay more (paraphrasing) 🤗" (reads back of the page: a list with my medication).

Is this shit even legal? I'm fuming. They pretty much identified what med I use and did 2 separate moves to drop me or something. Funny how I don't get my dues back!

My family are U.S. citizens, and we currently live in Massachusetts. My mother really wants to bring her 92-year-old mother to the U.S., but our main concern is that she wouldn’t be able to afford private health insurance, and we’re unsure how much it would cost. My mom spoke to a lawyer, who said she could get a visa/green card, but she would have to sign a form agreeing that she cannot receive Medicare from the government. Both my mom and grandma are feeling very sad because she wants her mother to live her last few years to the fullest and enjoy life. Does anyone know if there are any insurance options available for her? Would appreciate any advice. Thank u!!

My secondary is Tricare and my primary at time of visit was United Healthcare. Tricare is by law always secondary, but the clinic had it listed as my primary provider so UHC refused to cover the bill. I was 19 at the time and my mom was the one receiving all the emails and invoices for this, so I didn't know about it until recently, but because I was over 18 I'm the one responsible for paying. I'm not sure if UHC will cover the claim because it was from 2023 and I haven't been insured under them for over a year. Any advice would be really really appreciated, I'm kind of stuck here. Thank you!!

EDIT: I forgot to mention its in collections now which is why I'm not contacting the clinic to ask them to fix it. Again, I didn't know anything about it until recently.

Age:23 State: FL

Was in contact with a health insurance agent that informed me they needed my net pay (amount i make after taxes are taken out) instead of gross pay. To calculate for my insurance payment. I’ve checked online and many places say gross pay is what I should be imputing. Is my agent wrong?

I was overcharged 4 times the amount of my premium, but every person that picks up at Blue Shield immediately puts me on hold and I'm holding for at least 30 minutes before they come back and say they can't help me. It's so frustrating and when I ask for the billing department, they say they can't transfer me.I go through Covered California but Covered California can't do anything about Blue Shield over charging me. I just scoured the Internet for their billing phone number but the only result was their customer service number. Can anyone help me?

my child and i are currently on medi-cal. if their grandparent claims them on taxes, would there be any medi-cal implications or loss of eligibility for my child?

I have been on MinnesotaCare for a little under a year. The maximum income to stay on this insurance is $30,120.

In 2024 I made $34,883.

I am able to contribute $4,000 to a Traditional IRA (I already contributed $3,000 to a Roth IRA, so I can only contribute up to $7,000 total to any IRA) in order to reduce my taxable income to $30,883.

That still puts me $763 over the $30,120 income limit.

I reported that I would be making even more this year, but after seeing my options on the open market with MN Sure, I am deciding to dive back down and stay below the limit (or make more and just max out a traditional IRA).

So I went over the limit for me year, what happens? When/will they come back at me with the “you’re too rich to be here, give me more money” or will they just kick me off entirely even though NOW I am making less than the income limit? Or will I get arrested and spend life behind bars?

Any information, advice, or a point in the right direction to do some meaningful reading and research would be greatly appreciated! Thanks.

I am currently 28, unemployed, applying for Medicaid or Essential Plan. I physically live with parents, but file taxes separately. When I called NYS, they said not to include their income or info on application, since I file on my own. However, the household part of the website makes it seem like I do need to list them. Can anyone help? Thank you