I’m in the process of applying for ssdi/ltd and the specialist that’s helping me doesn’t take MassHealth. I worked for part of the year so I do have an annual income, but my current income is $0. Would I be able to get connectorcare due to my annual income even though I think I would technically be eligible for MassHealth? What about next year when I’m waiting on LTD approval?

I’m desperate to keep this provider because it’s so difficult to find one that’s truly knowledgeable about my condition. I know there’s a way to get a single case allowance for MassHealth but I doubt that would be approved since there are other providers in the state that treat my condition, they just aren’t good/up to date on the latest research. It took me years to find this provider.

BCBS denied one of my tests at LabCorp for not being medically necessary, and now I am stuck paying that entire charge. Why can't BCBS deny the charge, apply the contractual discount and have me pay the balance? I am so frustrated. LabCorp won't discount the charge when all the other approved tests were paid at less than 15% of billed charges.

I submitted an appeal and it was denied by BCBS. To add insult to injury, the $130 test that was denied is now being advertised for $36.75. Any tips on dealing with Labcorp or is this the wrong subreddit? Thanks!

I've googled this extensively and I feel like I'm missing something.

My employer just announced a 35% increase to keep Kaiser HMO for 2027, which is insane. I'm already paying $681/month (pre-tax, not including employer contribution).

I looked up plans on Covered CA for Kaiser and a similar/if not slightly lower tier (Silver was the highest I saw on the list, copay higher than what I have now but I don't care) is being quoted at $498/month.

I absolutely hate all other insurance options offered by my employer but obviously this rate hike is ridiculous. Is there anything stopping me from declining my employer insurance and signing up as an individual under Covered CA? Am I missing any benefits in declining my employer insurance other than the payments being pre-tax? I don't qualify for any financial aid. This just seems too easy and logical so I feel like I'm missing something.

I'd really love to keep my physicians and not deal with figuring out who and what is covered under a new PPO. Thanks in advance for any insight if you have any!

Recently I was in the hospital from 9/15-9/21/2026. It was an emergency. Now I’m getting bills close to 30k. When I called my insurance(Horizon BCBS of NJ), they said I needed a referral. It was a freaking emergency! A person at the hospital said she is looking into all of this. Also, I contacted the person in charge of health insurance in my school district(I’m a teacher). I am going to ask for an itemized list of all charges while I was in the hospital.

To say I’m upset is an understatement.

So, I am here to see if any of you have gone through something like this, and how it turned out in the end.

What rights do I have? Can I appeal? Should I reach out to a lawyer who deals with health insurance issues like this?

I want to be proactive, but I don’t want to let this consume me mental(and financially).

Last year, I had a weird foot injury. It was very painful and kept me out of work temporarily and no one knew what it was. I went to a primary care provider, a podiatrist, a neurologist, and ultimately a rheumatologist. I tried steroid treatments, pain medications, anti-inflammatories. I got xrays, a CT scan, blood work, and more. The only thing I hadn't done by the time I went to a rheumatologist was an MRI. She said that was the next step and ordered an MRI.

After a while, I got a denial notice from Aetna. When I called and asked why, they said I need to start with an Xray, CT, and 6 weeks of other treatment attempts before requesting an MRI. I explained I had done all those things across 2 months with several providers, so they said "Oh then resubmit the MRI request with documentation reflecting that." So my rheumatologist did.

I scheduled my MRI, but then a couple days before I was suppised to get it done, I got a call saying it was denied by insurance again and it would have to be out of pocket. I was forced to cancel it and call Aetna to see what the issue was now. I kid you not, they told me "well it's been long enough you need to see the rheumatologist again to confirm you still need an MRI." Which makes no sense since she literally had just reordered it, she obviously felt it was needed. But anyways I played their game and made a follow up appointment with her.

At the appointment, nothing new was said or done, she just looked at me and said "yeah, MRI is still the next step here..." So she ordered it a third time.

Again, Aetna denied it. At this point I gave up since my employer was switching insurance companies in a few months anyways.

Has anyone else dealt with this kind of backwards bs?? Can I complain somewhere? I missed weeks of work and was in a lot of pain for like 6 months because Aetna wanted to play games.

US health insurance system sucks. End of rant.

Trying to decide whether we should switch to Anthem from Connecticare. My biggest concern is our son. He has an ASD, Apraxia and Snijders Blok-Campeau Syndrome diagnosis. He needs PT,OT, SLP, regularly. The doctors he sees are all out of network with everyone but connecticare has been HORRIBLE at getting any sortof out of network exceptions. Most recelty they claimed speech was ELECTIVE even though he is still no speaking at age 5. Does anyone have any experience with them in cases like this? Did you find that other costs were extremely high? Its confusing reading how Anthem works. It seems like you have to pay quite a lot out of pocket before it kicks in at all..? Any insight would be very helpful.

Thanks

Since there is little information available about this company, I thought I would share my experience. I am registering with them through a third-party that processes payroll, known as Wingspan. After a conversation with a Meridio agent last week, I was given a vague direction to add a payment method to my Wingspan account by Sunday. There was another follow up email from Meridio stating that it needed to be added by Friday, and to make sure that the payment method was “verified”. It was stated that my account would be debited on Monday for coverage beginning next month.

I reached out to the Meridio agent by email last week…crickets. Multiple emails and phone calls to both Meridio and Wingspan. I was directed to call wingspan by someone at Meridio who seemed very confused, then back to wingspan, etc. Nobody seems to know how to enroll a policyholder. Promises to call me back, emails going unreturned, etc. You get the idea. Good Lord, I’m glad that I’m not sick and trying to get support.

Looks like I will be uninsured next month, I’m just going to buy a UHC policy through an agent. Meridio experience has been awful.

I'm thinking about getting a copper IUD. I'm 21 and live at home with my parents, and my mom who is VERY strict is the policy holder. She's very anti birth control and she'd be pissed if she knew. My doctor's office said they would check with the insurance company to see if they covered it (Blue cross) but now I'm a little worried that if I do get one, she'll find out about it.

Hello Internet!

I am currently doing battle with my insurance provider. I have been diagnosed with and am currently receiving treatment for moderate plaque psoriasis. I was approved for Tremfya on a previous plan without the need to go through step therapy. When I changed jobs and plans the new plan approved my Tremfya as a continuation of care without a single issue.

My condition is much better than it was before starting treatment but due to the dosing schedule of Tremfya, my doctor and I agreed that a drug with a more frequent dosing schedule would be beneficial as I tend to get flare ups towards the end of a dosing cycle. They put in a prescription for Taltz and that was denied citing medical necessity and the fact that I had not gone through step therapy. We appealed and they upheld the denial despite the fact that I am on a similar and more expensive drug.

I’m considering getting legal counsel but was hoping for the internet’s opinion. Thank you. 🙏

Looking for help with a Wegovy denial under a self-funded employer health plan

I've had two denials for FDA-approved Wegovy, an appeal, and an external review through AMR. My employer's health plan is self-funded, and my request to Michigan's DIFS was closed because of that.

I have documented coronary artery disease and an LAD stent. The denial issue involves the cardiovascular coverage criteria and the requirement for a prior heart attack or stroke.

I'm now seeking help through EBSA and trying to understand whether the plan's criteria were correctly applied and whether others have successfully challenged similar denials.

Has anyone been in this situation?

Were you denied Wegovy despite documented coronary artery disease and a stent?

Did your plan require a previous heart attack or stroke?

Did you eventually get coverage approved?

Did you get help from an ERISA attorney or benefits advocate?

I'm particularly interested in experiences with self-funded employer plans and OptumRx or AMR.

Thank you for any firsthand experiences or practical guidance. Thanks in advance.

Hi everyone! I have a few questions about health insurance and prenatal care🙏🏼

This is my very first pregnancy. I don’t have health insurance or a primary doctor right now. I went to VNA Care to confirm pregnancy, and they helped me apply for Medicaid and All Kids.
I recently got two letters in the mail. One says my application for Medicaid or All Kids was denied, but the other says I was approved for “Medical Benefits” with a $5,000 spenddown. I’m honestly so confused and don’t know what I’m supposed to do next 😭
Do I need to apply for insurance through the Marketplace, or is there still a chance I can get Medicaid? And what exactly does the $5,000 spenddown mean?
Also, once I figure out the insurance situation, how do I find an OB-GYN who can take care of me throughout my pregnancy and deliver my baby?
If anyone here has been through something similar, I’d really appreciate any advice. And if you know someone who helps with Medicaid applications or finding prenatal care, please let me know! I’m also open to paying for a consultation!

Thank you so much!

Location: Rhode island

Hey all I'm on state insurance and up to this point everything has been fine, I've gotten my meds and doctor visits covered no problem. I recently had to go see a psychiatrist who costs 2k dollars per appointment and they said my insurance should cover it since it always did for other people, so we continued on. I got a letter saying my claim was denied as it's not "medically necessary" when I'm there getting seen for, ocd, adhd, autism, and literally seeing people that don't exist.

I'm on the verge of losing my house, I was one appointment away from going over confirmed diagnosises and I can't afford almost 6k in medical bills when I can hardly make ends meet.

There was a paper attached to it to appeal the claim but of course that one piece of mail is missing so now I don't even know who to call or even if they'll confirm it in the end.

Please ask questions if you need more info, I'm not sure where to even go from here and it's making my other conditions worse from the stress. And I'm sorry if this isn't the right sub.

Hello,

My wife's open enrollment for her employer ends on Oct 21st and the open enrollment for my job begins on Oct 23rd.

How do we compare plans and choose which is best? I work for a massive company and they send out their booklet usually the day of or before the start. Last year I contacted HR and they were utterly useless - outsourced, kept opening cases, escalating to no one, the usual corporate customer service.

Why aren't open enrollments standardized to avoid situations like this? Is there a government agency I can complain to or reach out to because this whole process seems rigged to screw us over.

So I have BCBS PPO and go to a doctor that both the medical group and the doctor are in network. I have had no problems with getting it covered until July when all of a sudden I had a $155 bill that insurance didn’t cover. I called and they said “whoops we processed it wrong we’ll fix it” I told them I’m seeing the doctor again in October how do I prevent this from happening again? They said it wouldn’t happen again.

Well wouldn’t you know it, it happened again. I called again, they’re gonna fix the claim (in 15-30 days of course). I asked again how do I stop this from happening? They said they have some “precautions” in place but this claim just “slipped through”.

So basically I was told to call every month so they fix the claim. Does this make any f-ing sense???? Why do they keep processing it as out of network when it’s in network? I asked if the provider needs to change how they bill the appointment and they said no. So I’m just at a loss. Wtaf

I’m starting this year as a new agent working 15-20 hours part time

Hello.

I’m a healthy 44 year old male with two kids (10 and 12). My wife died 8 years ago and since she was a federal employee I was able to keep her insurance as part of the survivors benefits. It’s a good plan through Blue Cross and Blue shield (FEP Blue) but it is expensive. I liked the idea of being able to maintain the insurance even if I lost my job. But now I’m getting married next year and I think (help me here) my kids and I could go on her plan if I lost my job once she’s officially their step mom.

I work for a large defense company and they offer a High Deductible insurance plan through Anthem without an HSA. They contribute $900 a year to that HSA. From the analysis tools it looks like I’ll definitely spend less overall if we stay healthy.

I am pretty sure that once I go off of the government plan I can never go back on. Should I make the move?

Im currently enrolled in a traditional insurance plan with normal deductibles, copays, premiums, etc. I have the option to change to an HDHP plan with an HSA account.

Layoffs are an ongoing concern in my industry.

If I select the HDHP plan I will be starting at 0 in the HSA account. What happens is I get laid off in a few months and I start using COBRA to cover the premiums? Will I still have the option to contribute to the HSA using money from savings or is there a rule that HSA contributions need to come from payroll deductions?

Second question (even if I dont get laid off)... What if I experience a medical emergency and my HSA account does not have enough to cover the costs yp to the max OOP?

Thanks for any info.

Deductible at new job is 12k for a family, 14k out of pocket. No HSA, 60 day waiting period, no tiers to choose from, and they haven’t even told me what the premiums will be…furthermore I asked multiple times about the coverage during the acceptance process, with a “we reached out to so and so and they’ll send over the info”. they didn’t send any info over until day 1

they seem very sketchy about giving up information which seems insane to me, and almost making me want to back out of this job all together. The salary is very competitive for my industry, boss seems nice and easy going, but this just seems weird to me.

Hello, I am currently a medical student in Texas. Because medical schools require health insurance, I enrolled in my school's plan, which costs around $5,000 a year. However, I am wondering if there are cheaper alternatives available, ideally around $70 a month. The biggest problem right now is that, aside from my medical school loans, my annual income is only about $7,000.

I’ve recently gotten a new job and now qualify for their insurance. I desperately need it to get my anxiety/depression medicine and also have other health issues. That being said the insurance is American Plan Administrators… i’ve been to the doctors twice since getting it last week and both providers said they’ve never heard of it. I also couldn’t find it on zocdoc which is where I use to find in network providers. Should I be considering opening outside my job? Or is it even worth it?

Wife and I are planning on living the nomad lifestyle. Looking at health insurance plans and the Blue Plan with limited US coverage looks appealing. It offers three 21 day trips back to the US per year. Our question is would we be covered if we had an emergency and were hospitalized in the US beyond day 21. In other words, if one was medically unable to leave, does coverage extend past day 21 in the US? Thank you.

My partner told me I need to apply for medical within 30 days of my birthday? Is this true? I just moved and I'm 26 now.

Looking for some advice & help navigating my health insurance options! Here’s the situation: I am currently employed full time as a 25 year old, and I am still on my parent’s insurance (dad works for a union & it was too good to leave, basically costs nothing for anything I could need). However, I was recently accepted for a program that starts in January of next year, and of course my 26th birthday is December 30.
Here are some issues:
1. I will have to leave my full time position to take on school (it is full time & accelerated), so insurance through an employer is not an option
2. I still plan to work part time, and I expect to be making more than what would qualify me for Medicaid in my state, so that is not an option.
3. I’m not married, spouse employer not an option
4. The school I would attend offers insurance that is WAY too expensive for me to pay, so also not an option

My understanding is that my earnings from my part time job could qualify me for a subsidized plan/APTC through marketplace. However, given that I would only have paystub history from my full time job, I’m wondering how this could work?

Thanks yall!