Hi! I’m currently searching for health insurance in Nevada (Vegas specifically), & I spoke with a broker through the nv marketplace site who really recommended Ambetter insurance. Cost-wise, this is looking like the best option as both HPN & BCBS have insane deductibles with high monthly premiums. The only issue is, I’ve seen a ton of terrible reviews for Ambetter. I looked through Reddit, and one person said that they think the service you receive depends on your location. Does anyone have any advice on this?

Any opinions on Ambetter? For context I’m a chronically ill woman in my 30s. I’ve been uninsured for over a year bc of cost, and I really need good health coverage.

I have anthem which recently switched to carelon (which I believe is in house) for pharmacy. It is one thing after another with them. Hoop after pointless hoop. My doctor called twice to try to do a prior authorization on the phone because the website they use was glitching. He was told on the phone it was received and pending. Carelon says they never got any phone call and one rep actually called my doctor a liar and said "we don't lose requests."

So I ask for them to fax over everything to my doctor. They say they did, my doctor doesn't receive it. This happens twice, the third time they say "by the way here is the code." Turns out they hadn't been sending an actual fax but an electronic fax to the website that isn't working. So I ask them to send a real fax. They say they did. Doctor hasn't received it.

How tf am I supposed to get this prior authorization (for the med I've been on for two years) under review? And of course they will probably deny it on a technicality when it finally is under review.

I tried logging in to my member portal online and the issues have been endless. First it says to do double authentication with my email then when i submit the email to send the authentication to, it says there is a technical error and to call the service hotline.

Then i call the service hotline and they want me to enter in my username. My username has always been my email to my knowledge…

I try and reset my username and then i enter in all my info and it takes me to a security question page.

It asks me for the answer to security question #1 without even showing me what the question is? Never had that happen before, how am i supposed to answer a question without knowing what the question is?

Once i try putting in random answers to questions that i think the security question might be, it gives me another technical difficulties notification and to call the service hotline.

The service hotline brings me to some call center with someone from asia that barely speaks english (no offense) and says they will send a username and password reset to my email.

I have them send the email apparently a dozen times and it never comes through. Yes i checked my spam and junk. Wtf do i do now? I told them ill just look out to see if i ever get the email and ill follow up tomorrow

Funnily enough i am getting other emails from BCBS about open enrollment coming up etc, but nothing about the actual email that i am waiting for.

Has anyone else had issues with this? It feels like im running into issues left and right. Its the end of the year and im getting alot of healthcare since my deductible and OOP max is met. I feel like it isnt a coincidence that all these issues are happening toward the end of the year when i want to check claims, find doctors etc…

Such a joke

My husband and I are moving back to California in early November, and I will be 31 weeks pregnant when we land. We are completely stuck on health insurance:

• My husband starts a new job with an ICHRA on December 1st, but our current income is of course $0.
• If we try to get Medi-Cal, processing takes time.
• If we buy a private plan for December, we'll hit our out-of-pocket max for December careonly for it to reset to $0 on January 1st, right when I'm due

With my due date so close, how can we handle immediate care and avoid this financial trap? If you've navigated a late-stage pregnancy move to CA, what would you do?

Okay so could someone tell me how this is right. I have a prescription that costs$14000 and it's name brand and that's what was billed to my health insurance, but when I picked it up from the specialty pharmacy and got home it says it's the generic brand of my medication so is there fraud going on where they charge the extra ~ $5k and somehow giving me the generic but charging my insurance for the brand name. Because how would anyone know the difference really they wouldn't care as long as there's no copay you wouldn't care what they bill your insurance but someone is making money in there somewhere other than the drug company wouldn't you agree ? Or not agree? Please any info would be great. The med in question is called epclusa .

My wife (28) and I (30) are planning a pregnancy for next year. We each have employer coverage, and we're planning to split plans instead of putting both of us on one family plan. I've run the numbers, so I'm mostly looking for a gut check on whether it makes sense to split and if anyone else has done this.

Planned setup:

• Wife: Her employer's Aetna or UHC PPO: $70/mo premium, $400 deductible, 10% coinsurance, $3K OOP Max (+$1500 in prescriptions). Prenatal visits are covered, and infertility treatment is covered up to $25K max.
• Me: My employer's Aetna HDHP: $0/mo premium, $1,700 deductible, 10% coinsurance, $5,500 out-of-pocket max. I'd max my HSA, invest it, and pay medical bills out of pocket.
• Baby: Added to wife's PPO after birth (own $400 deductible and caps).
• Wife will skip her employer's general-purpose health FSA so it doesn't disqualify my HSA.

Our logic for the split is that my wife’s medical costs will be high and predictable (hence the PPO), while mine will likely be low. Adding me to her plan would cost ~$1,540/yr more in premiums and end my HSA contributions, while my HDHP is free and lets the HSA grow invested for decades.

What we've accounted for:

• Deductibles and OOP maxes reset every January, so if trying plus pregnancy spans two calendar years, we could hit the caps twice.
• medical coverage costs will likely be low as most medical expenses (prenatal care, delivery, baby's care) are billed to the mother/baby. My costs would range from nothing to carrier screenings, fertility evaluation, and male infertility treatments.
• My plan covers basic male infertility care but NOT IVF-related procedures like surgical sperm retrieval or sperm freezing. The odds of male infertility are relatively low, so I'm willing to take the risk. Worst case, if we discover male infertility, I can join her plan at the next open enrollment.

Open questions:

1. Is there a structural reason couples avoid splitting like this during a pregnancy or fertility treatment?
2. My wife's company offers Aetna and UHC while I am on Aetna. Is there any advantage to both of us being on Aetna, even if the plans are different? IF not, her UHC plan has better benefits.
3. Are there unforseen expenses that can be billed to the father that I'm not accounting for?
4. Any problems with coordinating care, billing or preauthorization when partners are on different plans?
5. Anything about the HDHP side I'm overlooking that would make this a bad idea?

Thanks in advance!

Long story short I’ve got some issues going on with my health that require some expenses that I can not cover out of pocket. I haven’t had insurance since I was 18 from Medicare(?) I think I’m not too sure, can’t remember. I never bothered to look in to other options because I didn’t really make enough money to afford the monthly payments on it.

I don’t think I make enough now either but I am at a point where I have put off what I need health wise to where it is now affecting my ability to work. I make on a good year roughly 10k~. Is it feasible to even find insurance that I could afford? And if so, how do I go about finding or applying for it?

Edit: I currently live in Georgia sorry forgot to add

My partner is expected to give birth within the next month. She has health insurance through work and will be going on maternity leave. I have my own health insurance, and I have until 10/30 to make any changes for this year.

Should I add her to my insurance plan before she gives birth? Would having 2 insurance plans be better than 1? Would this reduce out of pocket costs? Anything else I should be aware of?

Does anyone have a good recommendation for a supplemental insurance to go with Medicare? Would greatly appreciate any recommendations
Also are there any ones that cover prosthetic supplies?

Just got a very brief preview of the plans next year, won't know pricing until open enrollment in a couple weeks.

I've been on an HDHP plan through UHC for years because I max out my HSA each year for the retirement savings. Knock on wood, my health expenses are minimal. I see my primary doctor once a year for a physical and blood work, and that's about it. I'm on a few meds that are dirt cheap generics (I don't think my prescription med costs amount to more than $40 a year). I'm single with no dependents, so it's just me and the HDHP has worked out well.

Next year they're keeping a PPO option with UHC (although I don't know how much longer that will last, that might be gone in 2028) and the HDHP option is moving to Imagine 360 with a RBP plan.

I've done a bit of research on RBP plans and understand the gist of them. It seems like if everything health-wise stays as it is, it's fine for me. I'll pay whatever to see my doctor, he's been my doctor for over 20 years, he knows my medical history, he knows my family history, I'm not changing primary care doctors. If I have to pay more out of pocket to see him, I'm fine with that.

I guess where I'm stuck on is let's say something is needed beyond the annual physical. My doctor wants additional tests done, I wind up in the hospital, I get diagnosed with something major, etc. I'm 40 and not getting any younger here. I understand the RBP plan would pay the provider whatever they decide, and the provider may send me a bill for the remainder. That's where things become unclear.

Supposedly, i360 will fight on my behalf to get that bill waived, but how successful is that? That's really what I'm trying to figure out, how successful that fight is. I've read a lot about what can theoretically happen, but what I'm not finding are a lot of actual real world experiences from people who've either gotten a huge bill waived, or been stuck paying it.

Can someone help me shed some light on this? Thanks!

And yes, I know ultimately my employer is trying to fuck us over. It is what it is. I might be on the job hunt sooner rather than later but need to figure out what's best in the meantime.

Hey yall, I am currently on a student insurance plan and have my early checkup coming up. My plan gives full coverage for various preventive care services, and at least for the time being I plan to do these tests at my upcoming doctor's visit.

1. Physical checkup/examination
2. Bloodwork
3. Urine Test

My goal overall is to be able to get as much information as I can about my overall health, and am wondering what other preventive labwork / tests I could add to this visit, if any, to assess other important health markers. For example, ideally I was thinking of asking my doctor about these tests:

1. Kidney / Liver Assessment: LFT (liver function test); EUC (Electrolytes, Urea & Creatinin); eGFR (estimated Glomerular Filtration Rate - cane be measured from creatinine levels in blood / urine)... Can these be lumped into the normal bloodwork testing?
2. Lipid Profile Testing
3. Blood Glucose Test (I think this and/or A1C will be tested in the bloodwork)
4. Lifestyle/diet assessment

Are there any other preventive care tests/services I should ask for or mention that would be covered by my insurance plan? For example, I'm curious about my health as it pertains to my gut/digestion, spleen, gallbladder, lymphatic system, and sinuses/throat. I'm not sure how much I can know about the health of these other organs / systems simply through the general bloodwork testing... I don't have any symptoms that would make me think anything is necessarily critical any of these other organs / systems, which is why I would think this should fall under the category of preventive health care/services/testing and should be covered by my insurance.

Not sure if anyone could offer any thoughts or ideas, thanks! (I know AI could probably give me some good answers on this, but honestly I'm trying to boycott / limit my AI use as much as possible these days)

Our disabled daughter is treated at Texas Children hospital.

We managed to get a Charity in Poland (we are citizens there) to cover portion of her treatment costs however they require bills with my name and address on it.

All I’ve ever received from Texas Children’s were monthly statements.

I’ve requested bills several times both via phone calls and their „MyChart” portal but they straight out ignored those requests.
What is even more outrageous, during our recent phone call with their customer service, they suggested we should manually amend the statement and create a false bill. I was left speachless.

Can I make them issue an actual bill? How to approach this?

To add me to his insurance it’s $600/month. I have income right now but when I go back to school it’s going to be slashed and be about a quarter of what I’m earning. Am I just going to have to go without insurance or is there a possibility that I will qualify for marketplace even though I’m married?

Edit
I am 27f my husband is 26m
Right now we make around $84,000/year gross and when I go to school he will make around $42,000/year and I’m not sure how much I will make. I’ll be working a part time job at a food place so maybe $11/hr max 20 hours a week.
We live in Texas

Hi! I’m pregnant with my first. Due in December, insurance goes until February. I’ve met my deductible for the year and am close to meeting my out of pocket. I plan to add my child to my plan. But I plan to change the plan to a different United Healthcare plan that’s offered by my employer. I also want my husband to be on my United plan. My open enrollment is January (kicks in Feb. 1). My current plan is a $3,000 deductible for individual $6,000 for me and baby. Deductible rests when I add baby. The plan I want to switch to is a co-pay heavy plan with lower deductibles.

What’s the best approach here:

1. Add baby to my current plan on birth, wait until January open enrollment to change plan and add dad.

2. Add baby to my plan, change to co-pay plan. Add dad during open enrollment.

3. Add baby and dad to my plan, change to co-pay plan.

HRA does not do a very good job of explaining what exactly you can and cannot use it for. When it says ovulation kits what does that mean? Can I use it to get a higher end tester? Can I use it to get a smart ring or other device to track my body temperature? I am so confused

I’m a currently on my prior company’s health insurance plan, through Cobra. The plan year is from Jan 1, 2026 to Dec 31, 2026. I’ll probably renew through July 2027 (18 months). However the plan administrator (Igoe) said the new plan open enrollment is not until Jan 2027, and they will send the new plan information at that time. When I was an employee, the open enrollment started early Nov, and we had to sign up by Nov 30, to be effective on Jan 1. So, getting the new plan information in Jan 2027, seems too late to sign up, or switch to ACA if the plan costs are too high.
Is this timing for Cobra renewal normal?
I’m in California, if that matters.

I’m in Nevada.

TLDR: the COBRA insurance provider (UMR) will not grant me access to my 1.5 year old son’s EOBs because we opted in to a “dependent only” plan and his age is too young to create on online account. Almost a year with no action from UMR.

Longer Story (buckle up):

My son was born profoundly deaf in May 2025. We “chose” for me to stay home with him and I had to resign.
We had no plans to pursue cobra as my husband’s insurance is not great but also not terrible.
We chose to pursue bilateral cochlear implant surgery for him. There is no dedicated children’s hospital in a town that rhymes with Vos Legas.

At the time, husband’s insurance would cover care in SLC, UT. I am from there. We began driving 14 hours round trip once a month to that hospital for the 10-months surgery preparation process. He saw a renowned pediatric surgeon there. We stayed with my family.

About 2 months in, we were notified my husband’s insurance would no longer cover out of state care. We appealed but were denied and referred to a surgeon in San Francisco. We were also denied Medicaid (which I am appealing/pursuing Katie Beckett insurance which is a whole other post).

We decided to COBRA my former insurance because the UT hospital was “in network” (a very low tier of coverage but enough to approve the surgery) and we were already in process and a delay in surgery would mean a delay in his auditory development.

When I completed the COBRA form, I was able to opt into a “dependent only” option. I selected this for my son and remained on my husband’s plan for myself (because I don’t need out of state care!)

However, once we received my son’s policy number and attempted to create an online account for him, we hit a wall.

I entered his # and birth date (as required for account creation) but was hit with an ERROR page- the website only permits account creation for people 13+.

I reported this immediately to UMR to gain some kind of proxy access and was told they’d look into it. I called once a dayin the beginning, then once a week, then every month. I never got a call back, and every time I would call I’d get sent to IT, who couldn’t help me because there was no account set up. I got a supervisor’s number after several calls, who told me “many hands are on this case” but “federal law prohibits account creation for minors under 13.” They then stopped answering phone calls.

The surgery occurred March 17th 2026 (lucky boy). Payment has yet to be resolved. I have yet to be granted access to his account. I have yet to see an EOB from the surgery or any of the care provided before the surgery either.

I believe there was some kind of error on the COBRA end when they processed the opt-in form and neglected to link me as his parent to his account in some way.

Ultimately I cannot access his EOBs and I am not getting resolution from UMR.

Dear reader, I’m embarrassed about how long it’s taken me to come to this subreddit for help but I am at my wits end and tired of feeling like I have done something wrong which I may have? I am very tired and trying to teach my son how to hear. I am trying to learn ASL. I am trying to do everything I can and a TECH ISSUE is taking time away and dignity from my life. Please advise.

24y F, resides in oregon

Not sure what to choose. I have chronic migraines. Up to 10 per month sometimes. I plan on being referred to specialty soon(neurologist). I take monthly medications and potentially a preventatives: Nurtec and Ubrevly. These medications OOP can cost $2800 together ugh. I want to choose the best one for my situation. I go to the doctor 3-4 times a year.

Cigna PPO: $220.09 payroll contribution per check, $1500 deductible, $5000 OOP

Cigna HSA Buy up plan: $93.32 Payroll contribution per check, $2000 deductible, $6000 OOP, $750 HSA contribution from employer

Cigna HSA Base plan: $51.71 Payroll contribution per check, $4000 deductible, $8000 OOP, $750 HSA contribution from employer

2 weeks ago, I made a mistake of updating 2026 and 2027 income wrongly, and the system auto-remove me from my previous VHP plan for Medi-cal.

After I found out, I quickly changed my yearly income back correctly, and sign up for my VHP plan for both years again.

However, today I found out they terminated my VHP plan for the rest of the year and canceled the renewal for 2027. My 2026 displays 'Household members not eligible to choose a plan'. Is this because it auto-add me to Medi-cal? Should I call them?

hello i’m a 17 yr old, my sibling has a different health insurance since we’re half siblings but my mom is single and very low income, while im on my fathers work health insurance. i have no idea how health insurance works yet, but it’d be nice if i would have some help. not very sure how to go about this, was stressing last night.

recently i’ve booked an appointment for my little brother so he can get his vaccines for school. booked it at a walmart pharmacy, i didnot think any of it until the pharmacist told me it’s a medicaid card that isn’t going to be covering the cost of the vaccines. canceled the appointment, and did some research. i saw that i must go to this primary care provider (pcp) or else it will not cover it. tried to see if i could book an appointment but said he’s not accepting new patients. never seen this person before, not sure how to change it. the one my mom uses is WELLPOINT medicaid. my mother is not able to afford to pay off large amounts even if it’s a payment plan of $200. Please im in need.

My husband and I live in the Bay Area and he just got a new job that we’re so excited for. It will overall significantly improve our finances and quality of life, but we do have to switch insurance providers from Kaiser (which I’ve been with my whole life up to this point) to Aetna. Because I’ve only ever dealt with Kaiser, I don’t have a clue as to how out-of-network versus in-network providers work. I know we’ll be using John Muir as our new hospital, but do I need to be concerned about accidentally choosing an individual doctor that doesn’t take our insurance?

I did look on John Muir’s website to see if our insurance plan is accepted, which it is, but I still don’t know if that means all individual doctors at John Muir take our insurance. I feel like a complete dumbass for not knowing this, Kaiser at least felt simpler to use in comparison. The biggest reason why we want to figure this out for sure is because I’m pregnant with our second child and planning on giving birth at John Muir, but I’m a bit panicked that somehow a doctor that isn’t in-network will provide care for me and then our insurance won’t cover it. If anyone has an explanation it would be much appreciated!

Quick side note, I don’t need input on the quality of Aetna since we don’t have a choice but to use it, I’m really just needing advice as how to the out-of and in-network thing works

I’m freelance and buy my own insurance on marketplace in CA. Currently Blue Shield of CA PPO.

I am a carrier for a dominant genetic condition that requires preimplantation genetic testing and IVF to avoid passing on.

I read that reproductive coverage is coming to individual plans in CA, but I don’t see evidence of that in the 2027 plans I found on the marketplace online.

Do I have any chance of getting covered?