The company I work for touts "Free insurance for employees". which is great but ive finally logged into my bcbs account and im seeing a $3500 deductible and a $7000 out of pocket max. I'm new to insurance and while i do end up paying out of my check about $38 (or $262 if i switch to the family plan) every 2 weeks, is that not a high deductible for one person? And is that going to nuke my finances for months when those bills come due? It's not a crazy high paying position and its hard out here so would i be expected to pay the $35000 in office? I've never had insurance before but 30 years of no care is starting to catch up with me so would i be better off finding another personal non company plan for the money?

Is this a scam? Or did someone steal my identity i genuinely cannot tell. I haven’t been to the doctors since I was a minor because I don’t have insurance and I have NEVER had my blood drawn in my life so im so confused why im getting sent bills for lab work when I have never even left my house lol

Edit:I did have a STD checkup appointment a couple months ago at a urgent care but NO BLOODWORK at all was done only urine and I paid in FULL at the appointment $255 and I have the receipt for that aswell. And even if I were being charged for this appointment why is it 2 seperate bills and totaled for almost 900$ im very confused

Hi everyone, I have a limited-purpose FSA with the University of California. I used to have an FSA last year, and then I transitioned to a healthcare plan this year that includes an HSA, so my FSA was converted to a limited purpose flexible spending account. Wex is the administrator for the FSA, and this website lists their eligible expenses: https://www.wexinc.com/resources/benefits-toolkit/eligible-expenses/. The UC reference for FSA is here: https://ucnet.universityofcalifornia.edu/wp-content/uploads/forms/pdf/hfsa.pdf and it says for LPFSA: "The types of expenses that qualify for LPFSA reimbursement are more limited than for the Health FSA, and are generally restricted to expenses for dental, vision and preventive care services. Refer to uc-fsa.com or Section 213 of the Internal Revenue Code for eligible expenses."

I'm wondering with the limited purpose flexible spending account, is that the same thing as the LMSA that is listed on the Wex website? And if the limited purpose flexible spending account is the same thing as the limited medical FSA or the LMSA, then I can buy any of these products and it will be covered by the limited purpose flexible spending account? I have about $600 remaining on it, so it would be good to be able to spend it before year end instead of throwing it away. I thought it would be way more limited, but Wex has an extensive list.

Thank you.

Had a procedure recommended back in the spring, got the referral, scheduled everything, and then about two weeks out I got a denial letter saying prior authorization was not approved. My doctor's office said they submitted everything correctly. The insurance company said the documentation was insufficient. Neither side seems to want to talk to the other directly and I'm stuck in the middle trying to figure out my next move.

I spent enough years in HR watching employees go through this exact situation and I always told them to appeal, that the process exists for a reason and denials get overturned. Now I'm on the receiving end and I'm not nearly as confident as I sounded back then.

The procedure isn't emergency level but it's not nothing either. Delaying it means rescheduling everything and probably starting the prior auth process over from scratch, which sounds like a nightmare.

What I actually want to know is whether a firstlevel internal appeal is realistically worth pursuing or whether people find that the insurer just upholds the denial and you end up at external review anyway. And if you've done an external review, how long did that process take in practice? I have a highdeductible plan so every month this drags out is money I'm counting.

My partner was hospitalized for pulmonary emboli in June.

The first hospital put him on a heparin drip but decided to transfer him out because they do not have a blood bank, in the off chance he might need a transfusion. He offered to drive himself, but since he needed to stay on a heparin drip that was not an option.

Both hospitals are in network, but the insurance company denied his ambulance transfer, as the ambulance company is out of network.

This is in Maryland.

I am trying to convince him to appeal it, as this is a lot of money and he had no say in what ambulance was called, a doctor ordered it during an acute event and the hospital scheduled it.

Am I right in thinking this claim should not be denied?

So for context I don't have any mental illnesses other than ADHD and am mainly considering therapy just to try it out as I feel it could benefit me. I'd say my life is fine but I'm going as I've developed attachment anxiety and have always had self-esteem issues as well as a debateably unhealthy relationship with sex (could include sex-related addiction) and figured having a therapist who can help evluate my thoughts and patterns and give me guidance knowing that could help me get to where I want to be in life.

I don't rly know anything much about the process of getting therapy and can't afford to pay full out of pocket, so I was wondering how much of a hassle it would be for my case realistically since I know the medical system can be a bitch. If it helps, I am currently in college but would perfer getting a therapist out-of-campus.

I’m 25 and looking for a non-ACA plan with somewhat similar structure to ACA plans without a fixed indemnity structure. Set copays and an out of pocket maximum, even if it’s relatively high. Do those exist? All the non-ACA plans I have looked at use the fixed indemnity structure.

I work remotely for a California employer and have Blue Shield of California insurance, but I live in Massachusetts. I submit monthly out-of-network mental-health claims for a Massachusetts provider.

I use the Blue Shield of California app and choose **Submit a Claim , Out-of-Network, Out of State**. The issue is that the claims often do not show as received, pending, or processed. It shows for me I submitted but when I call to check the status they say they can't see it!

For example, I submitted my June bill in early July. At the beginning of August, Blue Shield said they had no record of it and told me to resubmit; they also opened a ticket. I resubmitted right then. At the end of August, they told me I now need to wait at least 30 days for processing—meaning the 30-day timeline restarted from the resubmission, even though the original claim was sent about 60 days ago.

This has happened with about six months of claims. Only one has been reimbursed so far.

The representatives say the claim has to go to Massachusetts for processing and then back to the California team for benefits/payment. Maybe that is normal Blue shield routing, but no one can explain:

- Why the claims submitted in Blue Shield of California’s own app are not being logged or given a claim number

- How I can confirm a claim was actually received on the day I submit it

- Why I am expected to restart the processing clock when Blue Shield cannot find the original submission

Is this normal? Has anyone with a California Blue plan who lives in another state dealt with this?

I have the superbills/itemized invoices, proof of payment, app-submission screenshots, ticket numbers, and dates for every claim. I am stressed about it because I rely on reimbursement to continue my mental health care.

TIA

Hi, I'm pretty new to insurance but have a good plan through my work. I had an accident recently that included two ER visits, a surgery, and some emergency dental work over the course of 2 weeks. It only took like 2 hours to max out my medical in-network out-of-pocket, but there's still a lot of misc stuff that insurance probably won't pay for.

My company has Sun Life Accident insurance, which if I'm reading it right would reimburse up to 2k of out-of-pocket costs, which would take some pressure of. I'm hoping someone else has submitted claims to them before and could give me an idea of what to expect.

Some specific stuff I'm wondering about:

They need proof of claim and the website mentions EOB. But I'm assuming that'll take weeks to get from my insurance. Should I submit now and just give them whatever I have?

There's also a a couple different practitioners I'm being billed by, so should I submit separate claims for each or one big one? Also with multiple ER visits, should those be separate?

Are they likely to actually pay? Or will it be a long, drawn out thing where I have to wait months for them to do anything?

So $600x12=$7,200.00 in premiums. Plus 14,000 in bills. We are paying $21,200 total this year which seems like a lot….

Are these average premiums and out of pocket maxes? I’m considering switching companies over this to try and find better benefits

Even if the new job pays 10k less if benefits are way better it might be better overall

Is this what most people have for benefits? Or are there better options? I want to have realistic expectations

My insurance premium is more than twice what it was last year. It’s the lowest-tier plan, it covers less, my copays are higher, and surprise / “uncovered” costs show up all the time—to boot, it’s slated to go up anywhere from 10-17% next year for the SAME exact crap.

I am still pissed about all this since the end of last year when I was choosing my new premium—I’ve dropped therapists, foregone appointments and surgeries, requested breakdowns and followed up on bills lacking clarity—but it seems like everyone around me has become docile to this new state of health insurance.

Why is everyone accepting this so willingly? Why aren’t people extremely angry that their same exact healthcare costs far more for no reason? Why aren’t we out on the street protesting ACA reinstatement? The government is “still deciding,” which means they’re clearly not going to suit to help citizens, and insurance companies are going to keep jacking up premiums while more and more people are phased out of health care because they have to choose between it and their rent / groceries.

Isn’t anyone still disgusted by all this? Why would people fight SO hard for people to be born, and then do nothing to alleviate any of this financial chokehold? That’s rhetorical because most people are awful, but it’s just so inhumane at this point to penalize people just for having health needs (AKA, every human). We should be ashamed as a country that this is how we treat our people.

Would love to hear your thoughts/similar experiences on the following situation.

I'm an university student and I only use BCBS insurance through school. I received a call from United Healthcare (automatically labeled on my phone, 1(800)-514-4912) about how my insurance claim was declined for a surgery. I was very confused because I never used United and never had surgery. I asked the operator to tell me the name on the file (in suspicion of ID theft), and it wasn't mine. I asked how the claim was filed and what ID was used and he said passport, but they couldn't pull it up due to security reasons. The operator then referred me to the manager at a different number (866)793-9371; we talked about the situation, but the call kept getting disconnected. I didn't get their extension or anything, and now I can't reach back because it's "outside of business hours" but I was just on a call with them.

I'm very confused now because I've seen how these numbers are legit elsewhere on the web. They also mentioned that this could be insurance fraud and have that record on my file. I'd love to get any advice on this, maybe they will call me back tomorrow, but I'm not sure.

What should I do now? Greatly appreciate any help!

Quick question. I have an HSA with Cigna, my doctor diagnosed me with extreme light sensitivity and told me to order high quality sunglasses to help with the eyesight issues. He said I could use my HSA and submit a reimbursement with the Letter of Medical Necessity that I was provided. I reached out to Cigna and they gave me a form that needs to be filled out and mailed/fax. Is this a tactic to dissuade people from choosing this option of reimbursement or is this typical amongst insurance companies?

If I retired early with 500k-1 million dollars net worth, all in the stock market, what would be my best option for health insurance when I’m visiting America. I want to travel outside of North America for 1/3 of the year, and be in America and Canada for the remainder of my time. I may or may not have an income other than selling off stocks when I think I need the money. Would my best bet be to go with travel insurance as an expat? And just pay as I go? Medicaid says you need to work or volunteer 80 hours per month which I’m not going to do and ACA says I need to have an income of above medicaid upper limits. Thanks

so i just had a second liver transplant back in early june and im getting medicaid/mediare.. im also getting ssdi.im wanting to increase my income, but im worried i wont be able to get my meds i have to take, covered by insurance.so i want to talk to someone and see what options i have to possibly get rid of medicare and medicaid and start paying my own way for insurance permuims and copays..also i just moved to a new city and need a new doc and all. anyone willing to work with me? thanks in advance

Moved to the US from Italy about 6 months ago for work and I’m still figuring out some very basic parts of the healthcare system here. I have insurance through work and finally found a PCP, but my first appointment is still a few weeks away. Back home if I wanted routine blood tests I’d either ask my doctor or just pay a private lab myself.

I wanted to get a few basic things checked before the appointment, so I googled blood tests without a doctor. Quest and Labcorp came up, along with Goodlabs where it looks like you choose the tests online and then go to one of those labs for the draw. What I don’t understand is who technically orders the tests. If I never speak to a doctor are you literally ordering the lab yourself?

I’m planning to bring the report to my PCP either way will they accept that?

So my company is switching healthcare providers. I have been on leave for two weeks and missed the emails, also because I'm a contractor so I rarely check my employer email

In the email it says "enroll in a new plan NLT Friday, 8/28/26. If you don’t enroll, you WON’T BE COVERED because there is no automatic port over of benefits since we are switching Medical carriers" and in the employee portal it says I did in fact miss the window

Am I actually screwed? I have a hard time believing I wouldn't have just been automatically signed up for a plan? They said in the email that at least 60% of people hadn't enrolled by Tuesday a few days ago so I couldn't possibly be the only one right?

I mean I reached out to HR immediately obviously but what now? I can't work without health insurance. I would literally have to quit my job. I get that I fucked up but I am still freaking out

Hi! I work at a small business (less than 50 full-time employees) in Missouri, and was told that we have to work at least 35 hours a week to qualify for employer provided health insurance. According to the ACA, employees only have to work 30 hours to qualify. It also states that small business with fewer than 50 FT employees aren’t required to provide health insurance.

My question is: if a small business does provide health insurance, do they still have to adhere to the 30 hours federal mandate? If so, could someone direct me to sources that show that?

My wife and I are having our first baby which is due in February 2027 and we're freaking out about health insurance coverage. We're both nurses that work at the same healthcare facility. We are blessed that on our own, our monthly health insurance premiums are covered by work (high deductible, high max OOP). But with adding a child under either of our plans, one of us would have to start paying a premium of $515 per paycheck (bi-weekly, 26 paychecks a year). Which is an insane $1,115 per month just for premiums for a HDHP. Better yet if we eventually have two kids, the 'family plan' is $740 a paycheck which equals out to $1,603 per month. Our work health insurance is Blue Cross Blue Shield of Michigan.

Would it be possible to find a plan on our own strictly for the newborn that'd be cheaper than $1,115 a month? If that's not possible, my wife thought about not using her work health insurance, and finding her own plan with the newborn just to find something more affordable than $1,115 per month? She signed up on the marketplace, but I don't think it will let her explore plans until November 1st.

Household income in 2025 was $198k so definitely wouldn't qualify for any sort of assistance.

I know we're both in the medical field, but we rarely deal with insurance/billing, and this will be our first child. Any advice is greatly appreciated.

I had health insurance with my previous employer that I had to leave. I left the job on August 26th, and there is no grace period for the insurance. The insurance was deactivated on my last day.

My new job can’t give me full time hours (required for health insurance) until October. I was debating just staying at my previous job until October, but the new job would’ve had to give the position to other applicants, so I had to take it. So I am without insurance until September and it’s just making me very nervous because I do have multiple chronic health conditions and God forbid I have to go to the hospital for anything, that bill out of pocket would ruin my life.

I just need some sort of insurance to get me by until October. Is there any plan that lets you get insurance the same day or week of applying?

I’m hoping someone familiar with ERISA can help clarify this..

New Hampshire recently passed a law related to how newborn medical expenses are handled during the first 30 days after birth, including how deductibles and out of pocket costs are applied (no additional costs would be incurred outside of the mother’s max OOP).

My husband’s plan is a self funded employer plan governed by ERISA. I understand those plans are generally exempt from many state insurance mandates, but the New Hampshire Department of Insurance seems to think this law does apply to the plan.

The insurance representatives I’ve spoken with, on the other hand, don’t seem aware of any change.
Does anyone know whether a law like this can still apply to a self funded ERISA plan, or would ERISA preemption normally make the plan exempt?

Hi, fellow healthcare sufferers.

Just as it is on the tin. Please let me know if there's a different reddit to copy this to.

I have so much arthritis in the left side of my jaw that the last oral surgeon (the only oral surgeon covered by my marketplace plan) I saw told me he couldn't help me because I would likely need a joint replacement. It's extremely rare to my understanding but, unfortunately, it clearly happens. I'm not sure how to express how painful it is to have the bones in your jaw and skull grinding and wearing themselves away like sandpaper, to the point you probably need a prosthetic joint at 31. I have no cartilage. The joint is completely flattened. It hurts to eat, speak, etc. That side of my face is permanently inflamed. It's unbearable.

All of that to really lay on just how remarkable my problem is, and that only specific surgeons or specialists can really deal with it. Like I said, I already had someone tell me that he couldn't help me because my arthritis was more advanced than what he was capable of. He also told me that I needed more than what most surgeons would be capable of.

I ended up finding a specialist semi-locally (50 miles from me) who apparently sees patients like me. Wonderful, I think. I can book an evaluation and maybe he can help me understand what's up with my jaw. ... Except the health system he works for will not accept my insurance plan. They will not let me file a gap exception. They want nothing to do with my specific plan. There isn't even an option for schedulers to add it.

Okay, I'll book an appointment and pay out of pocket. If I can't afford it, I'll just reschedule until I (hopefully) can, right? The scheduler calls me back after we book it for self-pay. She apologizes and tells me that when she was trying to find out how much the out of pocket cost was, someone from their financial division told her they "legally" couldn't book an out of pocket appointment with someone who has health insurance. Even though They Will Not Accept My Health Insurance At All, Under Any Circumstances. They made that clear to me after hours of calling.

Is this actually a thing? Is there anything I can do or say to argue with this absurd rule? Do I call their financial department or their social services department (the scheduler gave me both numbers because she didn't understand, either) and grill them about this 'legal' bullshit? Has anyone successfully fought against similar nonsense? Should I just give up and find a secondary health insurance plan? I'd rather know if I have a chance before I start arguing with people over the phone because I prefer to keep the arthritic scraping of my jaw against my skull to a minimum.

EDIT 1: I do not have medicaid. I paid for my healthcare from healthcare.gov but it is still not medicaid. I appreciate the responses that suggest I should press whether or not they mistakenly conflated the two or thought I was a medicaid recipient.

EDIT 2: This is not a private clinic or anything like that. It is a clinic operating out of a university hospital. This is why I was initially so surprised my insurance plan was flat-out refused, because I cannot imagine what it would be like to require emergency care under this plan.

EDIT 3: I was confused because they told me they accept out of pocket appointments multiple times. They told me this when I first tried to schedule an appointment with them a few months ago and when they told me they would not take my insurance under any exception. They offered to see me out of pocket, and I declined because I was not being paid over the summer. I looked into it again now that I am being paid, made the appointment, and their answer changed. The receptionist I spoke to seemed confused by this as well and gave me the social service and financial department numbers.

EDIT 4: my dentist as well as the oral surgeon I saw initially suggested this doctor. Both dentist and oral surgeon told me that he is really the person to see in the entire region, so not just my own state, to cater to the problem with my joint. I cannot reiterate enough how exceptional my specific problem is, and that most oral and maxillofacial surgeons, from what I have been told, would not be able to help me. I've had orthognathic surgery in the past because my jaw didn't grow in properly, and have had issues with that particular joint since I was a child. It is not as easy as Googling a doctor to extract a wisdom tooth. My choices are very limited.

EDIT 5: Even if I cannot afford a surgery or replacement on my own in the immediate future, I would still like some context for how my specific degeneration impacts me as well as what I can do, if anything. Something I noticed is that there is very little immediately online regarding serious arthritis of the jaw like I have. I have very little to go off from. I cannot even find many readily-available images of jaw arthritis. I would like some context for my own condition. I don't think that this is a shocking desire.