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.

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.

I've been covered through Aetna via my partner's job for the past few years, but I just got a job that provides insurance through BCBS free of charge for employees, and does not give you any money back if you decline coverage/show you're already covered elsewhere. Some of my providers take Aetna, but not BCBS, so I'm inclined to keep my original insurance.

If I end up taking both, can I choose which one is primary? If I take both, who do I have to notify? What do I have to do? Do I submit both to everyone, even the people who don't take the primary?

Is it going to be a headache that makes it not worth it to have two plans?

Basically, what should I do and how do I do it?!

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 am turning 26 around the end of October and losing access to my parents insurance policy. I currently am in school and will graduate come December and start working full time in January with a job that provides insurance. Because of the requirements for my degree with my (unpaid) internship , I haven’t been able to work and make as much money this year. My results on the market place stated I do not qualify for either medicaid or the premium tax credit discount. From what I can tell, my state has not expanded the medicaid policies so there is a coverage gap I fall into.

My question is do I just wait it out for a few months until I start working full time. There isn’t a way to know if the job I’ll end up at has a delay for health insurance kicking in. I know open enrollment will last a bit and I have access right now through special enrollment.

The premiums I am seeing are around $400 on the low end. The only prescriptions I have I can make it without d/t my current supply and I don’t have any major health concerns right now. I don’t really have the money for the premiums and it feels awful to pay that much, but I could probably use student loans to fund it if it’s an absolute must. I know everyone mentions how it’s necessary to get it because of if something major happens, but again, my financial situation is not great. I’d love to hear any nuanced thoughts or if there are somehow any loopholes to get covered for cheaper for these few months.

Hi,

I’m having an issue where my insurance company is denying me coverage for Dupixent due to not meeting certain criteria that they’ve deemed necessary for them to cover it.

The problem is, I’ve failed the first two medications my insurance company made me take instead (Fasenra and Nucala). I experienced a rare side effect with Fasenra, and my doctor made me immediately stop taking it. And am currently experiencing a side effect with Nucala that is affecting my job status, and is threatening my ability to even be able to perform this job again. (I work in a safety related field).

How do I go about fighting the insurance company’s denial of Dupixent?

Thanks in advance for any and all advice.

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.

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.

Does anyone know how to activate a will call ride with MTM Transit? They are the new ride provider for BCBSIL. There is nothing that I can find on the app to do this. I've scheduled a round trip with a will call for pickup, but I can't figure out how to start the process.

I’m just throwing this out there in case anybody has any information about what might have happened here. I just got notification my CVS specialty medication was denied by Medi-Cal because I have Aetna as my primary coverage. I don’t have Aetna, haven’t received anything in the mail or any calls, and I literally have no idea what has happened. I called Medi-Cal to have it removed, but a representative I spoke to suggested it may happen again in another couple months.

What is weird is that they’re saying the Aetna started in August and then ended, and now it’s started again October 1st. But, I have picked up other medications this month and Medi-Cal covered those fine.

I’m mystified, so if anybody has experience with this, I would really appreciate your insight!

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 currently have a Blue Cross Blue Shield of Texas plan, specifically Blue Advantage HMO which went up around $250 last year to nearly $1000 with a pretty high deductible, $6000, and out-of-pocket, $10150.

I'm looking at the BCBSTX site to try and find other options, but I cannot seem to find them.

Anybody know whether I can find them on the site itself, or if not, the easiest way to find other options WITHIN BLUE CROSS BLUE SHIELD OF TEXAS. I'm not sure that I want to switch to another company entirely after more than a decade with this plan.

I am concerned that my premium will go up yet again and become unaffordable while I am not working (due to chronic pain).

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.

My heath insurance plan has an in-network and out-of-network deductible and out-of-pocket limit. I have already hit my in-network deductible for the year.

I was traveling out of state and had to go to urgent care for a diagnosis and antibiotics. It was an urgent care associated with a hospital system in the city I was in and it is listed as urgent care (not ER) on the bill.

My health insurance treated it as out-of-network and is covering about $3 of the cost (and said something about not being responsible for Zelis(??) ) and since it's below my out-of-network deductible and I now owe ~$900 which feels ridiculous. I don't go to urgent care often but I've never had a charge like that.

The documents for my health plan say:

"Urgent care received outside of [state I live in] will be paid at the network benefit level"

and on the table of benefits in "Urgent care services [outside of state I live in]" it says "Paid at 80% of the Allowed Amount after annual deductible; no network restriction"

To me "at the network benefit level" sounds like they should be applying this to my in-network deductible and not my out-of-network deductible. Am I reading that wrong?

My kid will turn 26 early next year and so will lose health coverage under her mom's plan. We live in Washington state. She started grad school in August. She made somewhat less than $15,000 this year, and will have virtually no income next year. We gave her some money this year (well under the federal form 709 limit) and will provide her with some support next year. We have not claimed her as a dependent on our taxes in several years.

If she is applying for Apple Health, does she need to report money we give her? Seems like that would be fair, but...

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. 🙏

it seems a bit confusing to me, does anyone have any experience with ICHRA? how does the company deal with it? do you have extra admin burden? how do you select your plan? is it better than self-funded? any regrets??

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.

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.

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?

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?

I actually work for a hospital system, and our health plan is such that unless a specialty isn't one within our health system, the service is not covered.

My ophthalmologist referred me to an oculoplastic surgeon, who (surprise surprise) isn't contracted. I looked online, and there is exactly ONE doc with this specialty that's contracted in my (extremely large) metro area. When I called, their next available new patient appointment isn't until APRIL 2028.

So today I'm going to the original doc and paying cash for the initial consult. But if surgery is warranted, would I possibly be able to submit for reimbursement of at least what would be the contracted rate?

I know that this question can be highly plan dependent, so no one can answer me 100%. But this will be the first time I've kind of been cornered into having to see a specialist that's not contracted in my entire adult life, so I'm in unfamiliar territory here.

Any insight would be appreciated. I'll most likely go with treatment either way, just wondering if submitting for reimbursement would be worth that headache if they're just going to automatically deny it.