I'm 50 years old and had stage 4 uterine cancer at age 39 i live in Texas. I had aggressive treatment and was approved for cancer disability this provided me Medicaid insurance coverage. In March my coverage was terminated. I didnt think I would get sick, so I got a cheap 300.00 policy, but this policy doesnt cover much and im having to pay 2400 for a simple catscan using my insurance when paying cash cost 600. . The catscan found a tumor on one of my adrenal grands most likely cancer since I have lynch syndrome. I dont know what to do I have an appt with SSI to apply for cancer disability again and that is scheduled for mid Nov. However my Dr requested I take an MRI and see and endocrinologist and a urologist and a gastro. Apparently im not in good shape. I dont drink I dont smoke and im not overweight, but lynch syndrome makes me prone to cancers. In order to be approved to cancer disability I need to be diagnosed first, but i cant afford it. I did purchase a cancer policy so if I get a diagnosis of cancer I get a lump sum, however I cant afford to pay for the imaging or even the specialist. I am not provided Healthcare via my employer and Medicaid has denied me. Im single never married and no kids and looking for help in the form of finding an insurance that will cover me without having to pay thousands or even marriage just to be able to get a diagnosis. I am insured by Golden Rule a division of United Healthcare.

Please keep in mind as you read this I'm a type 1 diabetic who depends on insurance for insulin, and I depend on insulin to live. It's important context.

Amerihealth Caritas Next kicked me off their plan. Why? They wouldn't let me pay my premium. Seriously. That's the reason. They literally made it impossible. Here's what happened: I got a letter saying my account was past due. Particularly it said I paid only half of my copay for September. That was curious, because I was enrolled in autopay. I checked the website, and it said I owed nothing. Okay, so wait and see I guess? When I rechecked my account later, it said I owed two premiums and wasn't enrolled in autopay anymore. I tried to pay, but after entering all of my information and pressing "pay," it gave me an error. I was, however, able to re-enroll in autopay, which I did. Then I went back a few days later and tried to pay again, and it said "payment is not available for this account." I called them. The rep said it was because they changed their billing system and that I needed a new account to pay. Okay, first time I heard about it. She gave me the new account number and guided me through how to pay, but I got the same message: "payment not available." Then after some inquiry she told me I had been kicked off the plan because my account was overdue. She said there was a 15 day grace period and that I missed it. She encouraged me to see about coverage from the marketplace because open enrollment is coming up. I then asked her if I got the chain of events correctly: They changed the way I had to pay my premium, didn't tell me, blocked me from paying the only way I knew how, and were now kicking me off the plan because I didn't pay. She said that was right.

So here I am getting ready to fill some prescriptions for insulin and other diabetes-related medications/devices in the next week and I suddenly have no insurance. I'm not kidding when I say these prescriptions are out-of-pocket like $3000 dollars.

My theory is they did this little billing switcharoo to kick a number of people off their plans by administrative error because this time of year people are meeting their deductibles and the math stops making sense for the insurance company. I don't see any other reason. Otherwise, why don't they want me to keep paying them monthly for the rest of the year? Is my legal tender somehow not so legal or tender enough for them? If that's the case, and they don't like my filthy lucre, maybe they can they just cover me and not get their hands dirty with my coin. I'd be fine with that. We just need a solution that provides continuity of life-saving medical care. That would be optimal.

I have an active case open with them contesting this. We'll see what happens. I wanted to post here for public record. May their evil deeds shine brightly in the open light of reddit!

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 recently graduated and went from making basically nothing a year, to now next year expecting to make around $78,000 ish (PRN contract). Since I’m PRN at a hospital, not full or part time, I don’t get benefits through my employer so I have to continue using the government marketplace.

I’m terrified by how expensive my insurance is going to get, and I shared this concern with a manager who happens to control my schedule. She had the idea that that she could schedule me less hours for any month coming up, and that way I can turn in that pay stub to the government and base my expected yearly income off that month

I’ve always been someone who’s afraid of breaking or bending the rules in the chance that it comes back to bite me in the butt…. How likely is that to happen if I were to underreport my expected pay? In the past I’ve always gotten health insurance through my employers, so I’m not sure what to expect as a monthly payment now that I’m making way more money. I want to be truthful so I don’t end up owing money back at the end of the year, but I also don’t want to not “work the system” to my benefit if I have the ability to do so….. opinions please 😬

My wife, son, and I pay about $400 premium on marketplace. I am moving from the marketplace to my employee's plan. My son and wife will stay on the marketplace. Our income is not changing - nonetheless, our premium is going up $200.

One less person on the plan, yet the premium goes up - how does that make sense?

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 boyfriend (legal domestic partner) and I, both 20, are currently on my low deductible health plan. It has a 7k max, $0 deductible, and copays for doctor and specialist visits are between $40-120. Because he is my tax dependant, there is no imputed income.

I can switch to an HSA eligible plan with a $1500 employer contribution, but it has a $3500 family deductible and an 8k max. In April, his enrollment is open and he can also get on an HSA plan and contribute up to the family max. We both work warehouse jobs making just over $20 an hour. Our combined gross income will be just over 100k. I get ~15k additionally a year through chapter 35 and school grants. Both plans' premiums are covered entirely by my employer

I have few medical issues and don't see the doctor very often. My boyfriend however has ongoing joint problems that he's seeing pain management specialists for, and is on several medications. The copays for all of his care have so far been very manageable.

Is it worth dual contributing to HSAs? We could on paper afford to pay for care up to the 8k family max on my plan and both contribute the family max for the year, but do the benefits outweigh the lower copays in the short term? It is worth the imputed income from him no longer being a dependent?

Hi all! I posted this in r/Type1Diabetes a bit ago, and was suggested this subreddit as well. Please lmk if I am doing something incorrect - I am just desperate for advice!

I'm an Ohio native T1D (27, diagnosed at 19). This past year I was on Anthem BCBS and paid over $6k in 6 months for prescriptions/medical devices that by all accounts was supposed to be covered (at least partially) by them. DW, I'm in the process of fighting for claims to try and get some of that money back.

Anyways, here's my question: I'm looking for different insurance options for 2027 that offer better coverage in the state I'm in. My endo recommended Caresource back in April, but I've heard through the grapevine they won't offer coverage where I live in Ohio come January. Any suggestions on other insurance I should look into?

For financial context, I am employed full time at a small business hourly ($19) with no added benefits, so I'm lower income, but not quite low enough for any government support (I've been rejected by medicare twice).

Prescription context: I use the Dexcom G7 Omnipod duo. They are soo expensive but work too well for my health (currently at a 6.2 a1c!!) for me to want to change.

I'm looking around other sites and organizations as well for advice, but knowing that I am losing so much of my savings just to live is becoming soul crushing. I'm just at my wits end trying to find a better option and would really appreciate any advice or guidance you guys can offer.

Tysm in advance - I hope all of you stay well and healthy.

We moved from Kaiser to a PPO and are now with Sutter. My own records show up fine (shared hub, apparently), but my kid's record is basically just her birthday. So I called medical records to ask why the two are handled differently.

The rep's response, roughly, on loop: "I'm confused by your question." I apologized for frustrating her, said I was just trying to understand, and even offered — "if there's a better number to call, I'm happy to call that instead." No instruction given. Just more of the same narrative, at a slightly higher volume each round. She kept saying I confused her. I kept saying sorry. At some point I was apologizing for apologizing.

So, genuine question wrapped in a laugh: does the medical records department get this spicy these days? Is records transfer just a friction-filled contact sport now? Did I miss a memo? lol

(Not trying to get anyone fired — just curious if this is a "me" thing or a "system" thing.)

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?

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

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 .

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)

My Wife and I are having our first child in January and are figuring out open enrollment options. Scenario 1: My wife and I open enroll in an Employee+ Spouse Plan. Let's assume our deductible gets met by my wife's delivery costs. Does the deductible reset once change to a Family Plan and add baby to the plan?

Scenario 2: My wife and I open enroll as individuals through each of our employers. We add baby to my wife's plan. Does my wife's deductible reset once we change her plan from Individual to Individual + Child?

Cigna encourages us to use Evernorth - Express Scripts for prescriptions. Previously, they'd shipped from a location in a neighboring state and delivery had been quick and uneventful. This time, it shipped from a location much further away and USPS apparently misrouted it. It was supposed to be delivered yesterday but has just apparently been sitting at the wrong post office since yesterday morning with no movement. I'm out of one medication, but Cigna refuses to cover a small dose that could be picked up at a local phamacy. Apparently they won't do anything until the medication has been delayed for 30 days. Is this common?

I had a hyaluronic acid injection in my knee because I have severe cartilage degradation. Recommended by my doctor as medically necessary. If not this, I'd basically need either articular grafting or a total knee replacement. I'm in my early 40s so pretty young for a TKR.

Doc office said they'd contact insurance for pre-auth to make sure it's covered. Usually I get a letter from insurance stating if they did or didn't authorize; a few weeks after scheduling this appt, I still hadn't gotten this letter. So I called the insurance. They said they never got a pre-auth request. So I called the doc, they said they submitted one. Doc called me back and said the insurance company said no pre-auth was necessary. So I get the injection.

Well, I just got a bill for $5200 and that this claim was denied.

Am I screwed?

I called the insurance and asked about it, they basically just said it was a non-covered procedure, and that's what the EOB says too. I guess I just don't know what else I could have done here to prevent this.

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 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!

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?

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.

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.

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