So I don't know if I should sign up for my employers health insurance plan I don't want to and it's expensive. My husbands plan is available to me in January or something. If I don't sign up for the work plan and they ask about coverage being available through an employer and I were to say yes it was available and I didn't sign up how would this affect my coverage through his plan? I have been reading and all I can really find is that my plan would be primary and have to pay first if I had both. Can I be still penalized for not taking the plan at work? It's kind of a shitty plan (200 a month and a sky high deductible).

(I live in MA), Boston Medical Center called me to make an appointment with me for a specialist and told me I can see them the next day, I asked if I was covered. They transferred me to a different department, where they confirmed I will be. So, I went to the appointment.

I emailed my insurance asking about this, since I’m already in communication with them because BMC did not send a claim earlier this month to my insurance and billed me instead. Anyway, I was told that the provider I saw was not in network, therefore the bill will be my responsibility. I’m freaking out and don’t know what to do. Can I do anything about this?

I've had so many experiences with Quest for which the bill was billed wrong and it feels almost as if they are purposely trying to steal money from me. I have to spend a lot of effort trying to correct their bills. I've never had to call any healthcare entity for so much follow-ups.

The government announced bills under 500$ are no longer reported to credit agencies recently and I'm considering just ignoring quest bills that are under 500$ if I am not confident their bill is valid/correct.

Anyone else do this and have success either:

1. Avoiding payment without any consequences?

2. Forcing Quest to be more proactive to either fix the bill themselves or contacting you directly instead of you having to contact them to fix it?

P.S. This post is mostly just a rant. I just wanted to get some frustration off my chest. But I would also appreciate any advice or if anyone can share their experiences.

Hello all! Insurance matters confuse the heck out of me so I was hoping to get some advice here!

My husband and I currently have a plan through the marketplace. My 2 kids currently have a plan through FL Healthykids.

My husband just got a new job that offers what seems to be pretty crappy ins through Imagine360. So, I would REALLY like to stay with the Marketplace Coverage.

So here is the breakdown and where I am not sure if I am figuring stuff out correctly and need some help:
Husbands salary - 72,000 a year
My salary - can be anywhere between 12,000 - 20,000 a year (I am an Independent Contractor and it depends on how much work I am offered so no way of telling for sure at all how much I will make).

So, household income can be anywhere between 84,000 and 92,000 / year

Cost of the plan for Employee plus family is 318.33 semi monthly. We would have to do the whole family as kids will no longer be eligible for Healthykids. That's 636.66 a month. Times that by 12 its 7,639.92 a year for coverage.

My basic confusion is... Is that considered affordable for 2025? I see the affordable rate is 9.02% 9.02 of 84,000 is 7576. But, 9.02 of 92,000 is 8298. So, how can I tell really if it is considered affordable if I do not know how much I will make? What happens if I say no but I end up getting a lot of work and we end up being closer to 92,000?
Side note: He asked his employer if the coverage meets the health care law’s minimum value standards and they didnt seem to know really what that was but said yes. Not sure how confident I am in that.

Any help or advice you can provide is greatly appreciated. Both my kids have medical issues so coverage is of the upmost importance to us!

I was recently approved for Medicaid after being laid off for 7-8 months. However, I also just enrolled in my employer’s health insurance during open enrollment. Given that I now have both Medicaid and employer-sponsored insurance.

What should I consider in terms of coverage options?

Is it necessary to keep both, or would one option be more beneficial than the other?”

I have an HDHP and have been looking into getting supplemental coverage through voluntary accident insurance. However, everywhere I look, it seems like there is only group coverage available and no individual policies. Does anyone know where I should look?

NOTE: To be clear, I’m looking for supplemental voluntary accident insurance, NOT accidental death and dismemberment (AD&D) insurance.

Can we keep our 23 year old on our Family Health Connector plan if they have moved out of the home and have their own income? Do I have to report their income if they are not living in or contributing financially to our household?

I recently had a filling that I think is failing and it might be time to put a crown on that tooth, and my Dentist would agree. Would my insurance cover the 50% if I were to get a gold crown?

I'm now worried because they have a "2 year" limit for how long I can go until they'll cover costs again, but if it's with the same dentist as a result of a botched or failed procedure, I wonder if there'd be any exceptions … I can't find any resources for this.

It would help a ton if someone who either A: worked there B: has been through this with them or C: could find this for me, would have an answer. I swear, I've looked up and down. It would be greatly appreciated.

I've been working for a medical company and the annual enrollment came around. My wife and I recently got married. She is on medical and has no co pay at all. I have insurance through work(kaiser😒) that is ass and I'm not sure if I have to add her now that we are married. My out of pocket is bad everywhere, comparatively to her no co pay ever.

I do intend to file our taxes together this year but I'm unsure if she isn't covered by my insurance the IRS will come for us😬

I bought it through eHealthInsurance as I needed only a short-term plan. The web address that it sent me to is: myallstatehealthsolutions.com. Is this a legit website that is part of AllState?

Thank you!

I apologize if this is the wrong place to post this . If not allowed please delete. I wasn’t sure where to ask this question. I have been seeing a GI Dr. The clinic offers a procedure that is not covered by insurance. I have been paying 140.00 for this procedure. Today I called and made an appointment, the lady told me they had went up to 300.00 !! I was so sick that I went in and paid to have procedure done . Can they just go up on the price like that ? The company is trying to get rid of this machine for the procedure and is basically trying to out price it so people can’t afford to have it done and they can get rid of it.

I had back surgery few months ago. It was preauthorized by insurance and verified both surgeon and outpatient surgery center are in network. I paid 2k copayment on day of surgery which they calculated as 10% since I had already met my deductible. Now I see a claim in my insurance portal from surgeon for 20k. The eob shows a plan discount of 18k. Plan share of 1200. And my responsibility as 150. I called doctors office and they say insurance didn’t process claim per agreement and they are in contact with them to reprocess it. But it’s been over two months and I’m worried they will send me full bill. Can they do that?

I also see another claim from anesthesiologist for 2.5k which insurance paid 1300 and my share is 160.

There is no claim from surgery center and when I called them they said their part will be bundled and submitted with the surgeon claim.

title

I'm in CA. I left my job on October 18. My former employer said current coverage will end after 10/31. I don't like the benefits at my new job so my wife and I decided to add me to her employer's plan. My wife notified her employer at the beginning of October about the change and was told to wait until I leave my current job. So on October 18 she calls again and tells her employer to add me effective November 1. She was told by the same employee to call back October 31. Today she calls again and a different employee told her that it's too late, but I can start on December 1. My wife of course gets pissed off and explained what happened. The employee is no help even though the previous conversations were noted on file. Is there anything we can do at this moment? Covered CA is too expensive and if I join my work's plan I'm stuck with it until next year's renewal in July.

I have 4 herniated discs, had surgery for 1 a micro discectomy about two years ago. Went to the ER twice it was so bad and got a MRI both times. I saw a surgeon and he immediately recommended a micro discectomy which got done. Now my insurance changed and he got kicked off my plan, made an appointment with a new surgeon, now insurance is denying my MRI..I'm really annoyed on how I should go about getting the insurance to approve it from my surgeon. What should I do? Should I just go to the hospital again and get a MRI because the hospital is NOT allowed to charge medicaid patients at all and they'll do a MRI. The reason for insurance denying it is that I haven't had physical therapy within 6 months even though I had physical therapy after surgery. I would have made a MRI claim earlier but it took my doctor almost a year to find me a surgeon because I'm in a rural area. I already did physical therapy and it didn't work. Doing it again is a waste of time. My previous surgeon was hinting at doing either a fusion or disc replacement and ordered scans but my insurance changed so I couldn't get them done in time.

I just had to pay for prescription at CVS, but I already met my out of pocket maximum. Will I get reimbursed?

I just got married and I'm trying to see if its worthwhile to keep both my own current insurance (a PPO i've not had great experience with) and my spouse's Kaiser HMO. I'd like to change my PCP and all my doctors to Kaiser, and essentially use Kaiser for everything unless I am not in my home area or something. I would possibly keep my PPO more as a just in case because it is free to me through my employer. One example would be to get vaccines at a local CVS rather than having to go to kaiser for them.

Would this work? I understand since the PPO is through my employer, it would probably be my primary, but it would not cover the Kaiser doctors. Would that mean Kaiser HMO is immediately triggered as secondary and it covers the Kaiser doctors?

Hi, my sister is going through a lot of health issues. I have a good insurance. Shes 22, I was wondering if I add her as a dependent during my enrollment process, if theres a way for anyone actually check or validate it? What kind of trouble would I get in for this?

My insurance doesn't cover anything before the deductible is met, if I use a manufacturer coupon to pay for my insulin prescription will it count towards the deductible?

I'm very stupid when it comes to insurance and it's all very confusing to me so I was hoping someone could help ELI5 why my dentist is saying I need to pay more (I attached my EOB and the bill from my dentist).

I went to the dentist on Oct 3 and got 2 fillings. On the day I paid $61.80 which I thought was my copay. Now 4 weeks later my dentist is saying I owe them $76.20 saying that my insurance underpaid what they expected. Shouldn't I owe $52.20 which would be $114-$61.80?

So what happened?

https://imgur.com/OqC326M
https://imgur.com/EV83rXy
https://imgur.com/2O1yiiA - here's the EOB on my xray and exam

This is a throwaway account.

EDIT: To clarify up top, I am specifically referencing an inordinate amount of bills going to collections due to an error that was on the provider's part and not on either the patient's nor insurance's part. Namely, situations in which the mailing address matched the scanned IDs and the scanned, correct insurance information. The errors in question were made by the urgent care's billing department and/or receptionists, specifically. I'm not referring to the bills sent to collections due in situations were incorrect or incomplete information was provided to the provider.

It has come to my attention that an urgent care in my area has an unusually high amount of billing errors---errors that result in patients' bills never finding their way to the appropriate individual and instead being sent to collections. According to reviews on the internet and entries on the Better Business Bureau, this has been a BIG, recurring problem for at least several years and is an issue that extends to all 50+ of the urgent care locations (each location has its own google reviews). I imagine billing is done centrally and the errors are being made there.

If this is simply incompetence from the billing department (entering wrong addresses, names, CPT codes, etc.), why has the problem not been resolved yet despite complaint after complaint (in the 100s) on the internet? I have scanned other urgent care reviews and it doesn't seem to be a big problem elsewhere.

From the reviews, only a small percentage actually fight the collections agency, while most just begrudgingly pay the collections agency and just tell people to avoid the company. There also seems to be a lot of suspicious 5-star reviews to balance and drown out these reviews. Notably, every single of the 50+ locations to maintain a rating of about 4.8 across the board on Google.

Maybe I'm being overly suspicious, but is there a chance that this is not simply incompetence but purposeful? As in, they're might be collusion between the collections agency and the urgent care and kickbacks are taking place for a percentage of the urgent care's billing to be erroneously sent to collections? Or is there something else that could be going on?

Thank you all for your insight.

My last day with my employer was towards the end of June (I worked in NYC, but now live in WA). I was provided COBRA information at the end of my employment that informed me that WageWorks/HealthEquity would be my COBRA provider (Cigna is my insurer if that affects anything).

I had endless problems with WageWorks from the start. Despite registering for COBRA and paying my premiums over $1k/mo. Cigna showed that I had no active coverage. I had to go back and fourth with WW/HE for months, with at least 4 or 5 case numbers assigned, after which they assured me the problem had been fixed, but it hadn't been. Finally around mid-September, my Cigna coverage was reactivated. However, I received a bill from one of my providers at the beginning of last week stating my insurance covered nothing. I check my Cigna account, and it once again shows my coverage as inactive.

I followed up with WW/HE last Friday and escalate it to a supervisor. They told me that they have records of my payments as up to date, but that they don't communicate with Cigna directly. They apparently communicate this information to a "Third Party" who is then supposed to relay that information to Cigna, but it appears they aren't. They told me it shouldn't take more than 2-3 business days and to follow-up if I didn't get any information on a case resolution.

I followed up again today, where I was informed that they have in the file that they reached out to that "Third Party" yesterday, but haven't heard back. They told me they have no timeline on when I can expect the case to be resolved. I asked if they had any information on who this "Third Party" is, but the supervisor said that they aren't allowed to identify who that is.

I don't know what to do at this point. WageWorks seems unable to do anything about it, or just doesn't care, and I have no information about this 3rd party that seems to be completely refusing to do the job they're contacted to do. At this point, I'm planning on filing a complain with the New York State Department of Financial Services (which appears to be who covers insurance related issues rather than a dedicated Insurance Commissioner). The problem is, who do I file the complaint against? Is it WageWorks/Heath Equity as the provider, my former employer, or Cigna? It appears this 3rd party is the main source of the issue, but WW/HE won't provide any info on who that is in order for me to be able to file a complaint against them. And is the NYS OFS the correct body to be filing that complain with?

If you have any other potential solutions please let me know! Thank you all in advance for helping me with navigating this Kafkaesque bureaucratic nightmare.

I am going to travel to New York for 12 months to do an internship with a J1 visa. I have medical coverage from Envisage, but I would like to know if this insurance covers medication for pre-existing conditions, as I am taking Fluoxetine (prescribed by my doctor in Argentina). I need to know if I can obtain this medication in the U.S. with a prescription from my doctor, as I cannot bring a large quantity of medication when traveling.

This company literally steals your money. They decline every medical transaction you try to put through using funds that came out of your paycheck and then when you're unable to use them they absorb your money into their company. Don't give a dime to this shithole company you'll regret it !

Hi! I (28F) have insurance through my employer. I had a bilateral salpingectomy and a novasure ablation on 9/13/24. I received my EOB - $0, as expected, because of the ACA

However, on 10/21/24, I received a surprise $700 bill from the hospital. Immediately called my insurance; they said they would take care of it in 7-10 business days.

I called them back today asking for an update and we did a 3 way call with the hospital. Apparently it's a separate physician fee from the anesthesiologist???? And since it's not part of the facilities fees and wasn't coded as preventative, my insurance wont touch it and are saying it is my responsibility. I requested a re review of the coding, because under the ACA and the no surprises act, I should owe NOTHING for my bisalp since my EOB stated I owe $0, right? Please help/advise what I can do next. I don't even have $70, let alone $700 right now 😭

I have 3 options from my company regarding dental plans: Cigna Core: $8.50 semi-monthly (I currently have this) Cigna DHMO: $3.50 semi-monthly Cigna Plus: $16.00 semi-monthly

I am trying to compare plans but I absolutely cannot find any information on anything here except for Cigna Core. If it helps, I have a TON of work needing to be done on my teeth. Nothing pressing at the moment but I’m talking root canals, cleanings, fillings, dental implants, bridges etc, so expect my laundry list to be pretty expensive. If the more expensive plan allows me to save some money on these operations, that’s what I would like to do. Thank you in advance

Did anyone else get an email from Fitness Your Way saying due to “economic factors” the price of the Elite package is increasing to $129 starting on Dec. 5th then increase again to $199 Jan 1st 2025?

This is insane. I was paying $99/month pre tax for the Elite package. Now it’s going from $99 to $199!?! I’m out.

Which is better United health care of mass general brighams health plan

Hello. I am trying to decide which health insurance plan to choose. Both plans are HDHP. Both would be for one adult plus two children. Our complicating factor is that we see a functional medicine doctor for all of our primary care, and that doctor doesn't take insurance. We love this doctor and don't mind paying him, we just aren't sure which plan makes more sense given that we really only need health insurance for specialists, emergency care, or catastrophic diagnoses.

Details below with IN = In Network and OON = Out of Network.

Plan A:

Premium: $282 per month

Annual Deductible - $3,400 (IN) and $6,800 (OON)

Annual Out of Pocket Limit - $5,500 (IN) and $11,000 (OON)

Primary/Specialist Visit or Hospital Care - Plan pays 80% (IN) or 60% (OON)

ER or Urgent Care - Plan pays 80%

Pharmacy - Included in Medical Deductible

Plan B:

Premium: $182 per month

Annual Deductible - $3,850 (IN) and $7,700 (OON)

Annual Out of Pocket Limit - $8,500 (IN) and $17,000 (OON)

Primary/Specialist Visit or Hospital Care - Plan pays 70% (IN) or 50% (OON)

ER or Urgent Care - Plan pays 70%

Pharmacy - Included in Medical Deductible

As mentioned above, our complicating factor is that we see a functional medicine physician for primary care (and he doesn't take insurance).

I have two questions. First, can I submit his bills/invoices to my insurance, and if they do approve them as OON visits, would that count towards my OON deductive and Out of Pocket Limit? With Plan A, do I hit my deductible of $3,400 only when I have spent $3,400 on in network providers (so not this primary care doctor), and any out of network spending only matters when determining if I have hit my OON deductible or OON annual limit? Does in network spending count towards hitting my OON deductible? In other words, on Plan A I could spend $4,000 with the functional medicine doctor and $3,300 with in network providers and I would not have hit either deductible?

Second, given that we are receiving primary care form a physician that doesn't accept or process insurance, which plan makes more sense for us? No one in the family takes any prescription medication and no one in the family has any current chronic conditions or diseases that require ongoing specialized care (knock on wood). We basically only need health insurance for specialist visits, emergency situations, or catastrophic health events/diagnoses. Should we should do Plan B and pay the lower premiums to save $1,200 per year on premiums knowing that if we have an emergency situation we will be spending minimum $3,000 more (up to $6,000 more) to pay for our health expenses?

One last note, coming up with the full $17,000 OON max on Plan B, while not fun, would not be a problem if it absolutely had to be done.

Ages are 40, 5, and 3. Annual Income is about $325K plus bonus (usually around $100K) and equity grants (varies from year to year). I max the HSA each year, which should be $8,550 for 2025 but am trying to save HSA money for retirement and not use it for current medical expenses.

Any insight is appreciated. Thank you!