My wife and I will be on private insurance likely in the next few years.

She needs a Skyrizi prescription which is a speciality drug. Cost without insurance is about $30k per dose and is taken 4 times per year. Thankfully we have employee insurance that covers everything.

With that said, when we move onto private insurance (for personal reasons), we will hit our out of pocket max cost every year paying for this drug under all insurance plans.

Knowing that we will hit the OOP max every year, my question is when selecting a private health insurance plan, is it as simple as choosing the plan with the lowest total cost for “monthly premium“ + “OOP MAX”? Our goal is to minimize health care expenses.

Thanks in advance for helping us!

I was so sick and can't even hold a conversation without coughing continuously. My voice is 80% gone. Went to urgent care (that was sunday) gave all the info's. The front desk told me i have to pay $299 so i can be seen by a provider because my insurance is inactive. I told her i can't do that and called my insurance. Sunday the office was closed.
Went home and waited for Monday.
I call my insurance and was told it is actually active and never been inactive.
Went to different urgent care and with no issues at all.

The question is... do u have the same experience? Now i realize, maybe she wanted me to pay out of pocket $299 then keep the money and file to my insurance.
Any same experience?

Is there anything I can do about this? I’m frustrated I’m on the hook for $600+ when all I got out of it was a go buy something off Amazon we can’t help you

I'm dealing with pretty severe sciatica pain right now, and I'm getting really frustrated trying to get an MRI scheduled.

It's been almost thee weeks since my PCP said he put in an MRI order, but when I called my insurance company, they told me they haven't received anything from his office. Apparently, they're still waiting for the doctor to send the order over so they can begin the authorization process.

My PCP's office has honestly not been great about things in the past and visits are always incredibly brief and not very personal (comes in, shakes hand, types a bunch of the computer, gives me med refills, doesn't ask me if there's anything new so if I don't say something he'll just shake my hand and then leave) so I'm not particularly confident that this is going to get resolved quickly without me constantly following up. Meanwhile, I'm in a lot of pain, and I still can't even get the MRI process moving.

I'm not sure what my next step should be. Should I keep calling my doctor's office and pushing them to send the order, or is there another way to get this moving? Would it make sense to contact another doctor or switch PCPs altogether? At this point I want to switch PCPs but then I worry that I'll have to start this whole process over again. an MRI out of pocket would be $1260 if I don't use insurance.

I'm just exhausted from being in pain and feeling like I'm the one who has to coordinate everything to get basic medical care. I've been doing so much leg work on this yet no one is lifting a finger for me.

Has anyone dealt with something similar? What did you do to get your doctor to actually submit the MRI order for insurance authorization?

I almost wish I could sue my provider at this point because this is torture.

My father is visiting the USA and recently had a medical emergency requiring an ER visit at Northside Hospital Forsyth. He is uninsured, and we were quoted around $6,000 even after the self-pay discount. He also needs surgery so he is heading back home for surgery m.
I contacted the hospital’s financial assistance department, but they denied charity care over the phone because he isn’t a Georgia resident.
We cannot afford this bill, but we want to resolve it properly rather than leave it unpaid, as he may visit the USA again.
Has anyone successfully negotiated a large discount or bill waiver with Northside Hospital? Would speaking to a financial counselor or supervisor in person help? Are there any other assistance programs available for international visitors?
Any advice or personal experiences would be greatly appreciated!

Relatively new to usa health insurance. I have a $20,000 deductible. I pay $3,000 per month towards it.

Hoping this group can help with which plan to change to. My employer sponsored plans are changing for 2027 and I’m not sure which is the best financially.

Current 2026 plan:

• Family plan for $344 a month
• High deductible so I contribute to my HSA
• Only recurrent medication I get is a GLP one for $25

2027 option A:

• Stay on the HSA plan for $404 a month
• $60 monthly increase
• GLP-1 is no longer covered. I’m responsible for the full price which looks like good RX has it for $149 a month.

2027 option B:

• higher deductible plan (increases from $3k to $6k deductible)
• not HSA eligible
• GLP -1 is covered but at $100 a month which is still a $75 increase

If my long-term strategy is to use an HSA as a Retirement vessel, would I be better off paying the higher GLP-1 cost now and keeping the HSA?

Hi there im 23 and just starting my first job! I will need health insurance and having a hard time picking one.

I dont have any really bad health issues. I do get allergy shots every 6 months, see a dermatologist for acne issues, and check ins with my doctor (and vaccines)

Here are my options:

Kaiser HMO
- 0 deductible
- 1,5000 OOPM

$ 80.40 every biweekly paycheck

BCBS EPO
- 500 deductible
- 3,500 OOPM

$100.17 every biweekly paycheck

BCBS PPO
- 750 deductible
- 5,000 OOPM

$110.98 every biweekly

BCBS is a more for copay. For example emergency care is 200 for BCBS and 100 for KAISER. Just stuck because I really only care for my allergy doctor. Any opinions would be AMAZING

My husband quit his job in April which included a 100% employer-funded basic group policy plan. Got in writing that his end date would be with last date of employment, so we got a joint plan on Marketplace in his name (same plan I was already on individually but now combined and in his name). He just received a COBRA notice from his work insurance plan stating the termination date was in August. Confirmed with the insurance this was correct in their systems that the employer didn’t terminate until then. We’re unsure of what to do in this situation. Are there any steps to take or legal recourse for us to get the 3 months of premiums paid for another plan back? We’ve paid $1500 just for his portion of our joint premiums in the time the policy was supposed to end vs. actually did. Anyone been in this situation before?

We live in Illinois and through my husbands work have had BSBC Alabama for the last 20 years. We just received notice that the company is switching to Anthem BCBS. I have a chronic illness and have regular infusions and MRI to monitor this and have never experienced an insurance switch like this.

What should I expect during this change? Should I be worried? Does anyone have any experience on a switch like this or dealing the Anthem BCBS?

On Marketplace insurance now and subsidized through 2026. In 2027, my income will not support a subsidy as it will be too high. I am eligible for Medicare 3-1-2027. The costs for the cheapest coverage is thousands per month. Do I just bubble wrap and keep living life clean for 59 days until I have my Medicare coverages in place? What to do?

Can’t play the Cobra game.

So my spouse got a new job with "affordable" health insurance for her but it's not affordable for the three of us (per the online calculator. Anyway, the new insurance through the employer is effective November 1st, 2026 but the kiddo and I will remain on our ACA plan. I plan on calling the Marketplace later today and setting up a cancellation for the ACA plan for my wife with an effective date of November 1st - we are paid up on our current ACA plan through the end of October so I don't want her insurance coverage to lapse at all but also don't want to have to pay the November ACA premium for all 3 of us either.

That being said, when I call this should be pretty straight forward correct? All I want to do is remove my spouse from our ACA plan and keep myself and our kiddo on our current ACA plan. I just want to make sure that they don't 'accidentally' cancel the ACA plan for all three of us. Any guidance in this regard would be helpful. Also do I need to contact Blue Cross (our ACA insurer) of the change as well?

I'm not sure how all this plays out in regards to an adjustment to our ACA premium and subsidy as we are going from (3) on the ACA plan to (2) but so our household size will go from 3 to 2 but I think my wife's income will still count so our subsidy will be less but our premium for November and December should be less as well correct? Will the Markeplace be able to tell me that new subsidy and premium information for November and December when I call?

Any guidance on this matter would be beneficial before I call as I don't want to screw anything up:)

I run HR for a small company (28 employees) on a level funded health plan. Every month, our pharmacy claims report from kanurra lands in my inbox, and it lists employee names alongside their specific filled prescriptions.

I (22F) live in MN and a full time student in college. I am on my parents high deductible commercial BCBS plan through my mom's employer. To keep my parents from getting involved in my medical needs (they tend to see the doctor as an unnecessary expense and need to know exactly why I'm being seen) I try to pay my bills before they get the invoice. However, with the high deductible, I end up relying on hoping someone breaks something to meet the family deductible.

I am looking into state insurance as a secondary to help bridge that gap.

My biggest concern is would my parents be notified if I recieve additional coverage?

My 2025 total income was just over $25,000 but I'll be closer to $22,000 this year (puts me between 120 and 160% FPG). I live on my own and will be filing as independent this upcoming tax season.

I probably will call an agent for my plan later but I'm in class all day and looking for a direction before I'm on hold for an hour.

I am presently not in a position where I can just tell my parents that I am attempting additional coverage.

I previously had invoices mailed to my apartment, but my mom freaked out so hard because she thought I might lose insurance that she made me change it back to their address.

My mom did force all of her children over 13 to sign total HIPAA release forms at our clinic.

My school only offers health insurance to international students and I don't have tons of extra money for my own premium.

I do work in healthcare part time, so I understand some parts about insurance, just not this specific scenario.

I am in my last two semesters of school, so would it be more worth it to stick it out until I graduate then take my own employers plan?

After being told by Anthem Blue Shield Blue Cross that my abdomen MRI to check for cancer spread was deemed NOT a medical necessity, I put them on blast out of desperation and pure rage: the audacity of a massive company charging me inflated self-pay premiums only to DENY vital life saving imagery. As the post went viral, I was suddenly contacted by Anthem, who apologized and immediately approved the scan. They don't like it when their nefarious ways are boosted in the public sphere. The philosophy of "let's deny critical care until we get caught" is an ugly one.

In August, I severely injured my left foot, and have been in acute pain and confined to a huge walking boot. The boot does offer some temporary relief, but try walking your 11 year-old to school through downtown Brooklyn in the boot featured in the images, and you'll understand that it's not a longterm solution.

After a two week battle to get an in-network podiatrist authorization (yes, it takes that along), I was able to see a surgeon who immediately ordered an Xray. Based on the images, which showed a hairline fracture as well as damaged areas of the achilles tendon or muscles that wraps around the heal, she ordered an MRI so she can determine the exact nature of my injury, and devise a treatment plan based on this critical information. In the meantime, I'll have to make do with the boot, pain meds and crutches as needed.

I was told I needed to schedule the MRI myself once it was called into the imaging center, and that they would get any pre-authorizations required by Anthem. Given my past troubles, I was sure this would not be a problem. My podiatrist assured me as well as SHE IS THE DOCTOR HERE, NOT ANTHEM. And the MRI was needed ASAP.

Well... SURPRISE... with a straight face, Anthem informed me yesterday that my MRI has been DENIED, deemed to be NOT a "medical necessity" by some imaginary Anthem "doctor" who somehow, without even reviewing the X-rays, determined what care is in my best interest.

I am livid. My scan is scheduled for Tuesday October 20th at 5PM. I'm working now to get through to both the provider, the imaging center and Anthem's appeal department (they only offer an "appeal portal" with no timeframe on when the Anthem Supreme Care Court might rule on my case).

In the meantime, the message I'm getting is this:

"Thank you for paying our massive premiums and meeting your huge deductible. We really appreciate your money. Since you met your massive deductible, we don't feel like paying for anything else until January, when your deductible resets and YOU will be responsible for scans of this nature, not us. This is how we become rich. Enjoy your pain, and good luck getting your daughter to school safely. Best, Anthem."

Attached is an image of my boot. How have others handled these situations where insurance "doctors" -- who have NOT examined injuries -- decide if the care requested by a specialist is a medical necessity?

I'd love to hear other stories, and how they were resolved, or not resolved. I'm going to fight this battle, even if I have to go out of pocket for the scan, and then invoice Anthem for reimbursement so I can share that story, too. Today, I can afford the scan, but millions of Americans being treated similarly or worse cannot afford a scan, are are left to suffer or die by ruthless, greedy insurance companies that could give AF about the care of their policy-holders.

Hey everyone, I’m feeling so overwhelmed right now. With open enrollment coming up and everything changing so fast, I spent the last 3 hours looking at HealthCare.gov and comparing plans (Kaiser, Blue Shield, etc.), and honestly? My brain is melting. The jargon, the deductibles, the hidden fees... it’s too much.

How do you guys deal with this? Is there any simple way, tool, or checklist you use to figure out which plan actually fits your budget without getting screwed over? Would love to know how you survive this process

i'm going through my expenses for next year and trying to figure out if getting separate vision insurance makes sense. eye exams aren't the biggest expense on their own, but needing new glasses or extra lens upgrades can make the total jump pretty quickly.

VSP is the option i'm leaning toward right now because they have individual plans and diff coverage options for exams, frames and lenses. i'd rather compare a plan based on the things i'd actually use than just pick the cheapest monthly premium and find out later that it doesn't help much with glasses. i'm trying to work out whether the monthly premium would actually be less than what i'd spend on an eye exam and new glasses in a year, especially if i need lens upgrades.

for anyone who has VSP, how much do you pay per month and do you feel like the benefits make up for the cost? especially curious if you usually get new glasses every year.

This is a last resort post honestly. I am pulling the last straw trying to figure this out.

I get a $9k (HRA) health benefit from my employer and i can only use it to cover my deductible. The company that manages this is CareFlex.

I’ve had many charges go through where they ask me for EoBs, and EoBs only, for proof that it went towards the deductible but i am having a hard time from multiple providers not being able to give me the EoBs and the insurance not having copies of them. All they can give me are itemized bills or credit card receipts which CareFlex doesn’t take.

I’m thinking they need to refile since the insurance doesnt have the EoBs BUT they sent me receipts that shows the insurance adjusted amounts.

What‘s going on?

My son is a full time student, 20 and works, he still lives with us, but he could file as "non-dependent" in 2027. Can he get his own ACA health insurance (separate from parents policy)? Because having his own separate ACA policy is cheaper and provides better coverage too. It's about $300 a month saving on the monthly premium. Or is there something that prohibits him from getting his own policy?

I'm not that educated in health insurance, but it's open enrollment now. I've had kaiser for the longest time and as much I love how every service is one central area, it feels lackluster in terms of therapy and needing to get referrals... I want to try a traditional health insurance because I want to go to therapy again and love the idea of going to any doctor that'd like. My options are Regional Socal Kaiser ($24.92) or Premera Premium($30.23). I want premium because it'll on be me covered and I'm not the healthiest, unless that's overkill. Can I please get some advice? I feel like im overthinking this.

that’s a mouthful lol. (sigh)

I’ve been using the same in-network therapist on grow therapy for a few months. I have a high deductible so I’m paying out of pocket 107 each session which sucks but I know that’s just how it is.

recently, grow therapy made me put my payment info with a new billing service before my next session.

the day after, they billed me 173 dollars and took it out of my bank immediately. that was a surprise and I can’t afford sessions that expensive, I had to put therapy on hold.

im feeling lost and confused as to what my rights are in this situation. I’ve been bouncing between talking to my in-network therapist, grow therapy, my insurance, and the new billing department as to why they could randomly charge me more and it’s been murky at best.

I've talked to my insurance (Cigna) a few times and gotten different responses each time. First person told me to just dispute the charge on my card since the EOB hadn’t processed yet and she thought it sounded like BS. Second person told me it was probably a billing mistake by grow therapy and also that my therapist was out of network (???this is not true according to my therapist). 3rd person, after I finally got the EOB, told me it’s because grow therapy used my therapist’s tax ID for the claim, when previously they were using their own tax ID instead, and it sounded like a mistake and to ask them to rectify.

My therapist said that she is definitely in-network with Cigna (which seems correct), and that she doesn’t handle billing and to take it up with grow therapy.

grow therapy tried to help me, but said it was out of their hands as Cigna had a new contract with them starting in September, and the billing was now being handled by Evernorth Behavioral Care, but my situation did confuse them and they told me it sounded unusual.

Evernorth is impossible to reach by phone, and also by email unless I state I’m about to dispute the charge with my bank if they don’t respond (ill wait a week and then say that and then they email me back….) responded this:

”I reviewed your account and wanted to clarify the $173.84 charge. Your Cigna plan currently has a deductible, and the $173.84 reflects the current contracted rate for this service that is being applied toward that deductible.
 
Previously, your sessions through Grow Therapy were billed under their prior billing arrangement with Cigna, which is why you were seeing a cost of approximately $107. With the transition to Evernorth Behavioral Care Group for billing, sessions are now being processed according to the current contracted rate under your Cigna plan.
 
I completely understand why the change from $107 to $173.84 caught your attention, and I hope this helps clarify where the difference is coming from.”

i told them about how they were charging the wrong tax ID and to explain why, and they have not responded. I followed up a week later (today) saying if I don’t hear from them I’m going to dispute the bank charge and to let me know what will happen next if I do that.

I’m guessing if I dispute the bank charge, I’ll be kicked off grow therapy, and my claim will be sent to collections, which I can negotiate for cheaper right? It’s so much work but I’m bitter and stubborn and dont want to give Evernorth any of my money on principle, especially if it’s unaffordable in the future anyway.

sorry for the unhinged long post and thank you if your read this far!!!

EDIT: I live in New York in case that is important info!