r/HealthInsurance

Hello,

Last time I got an 8-panel STD test at a partner’s request, it cost $228. I have health insurance, but Quest Diagnostics said they do not take insurance unless the test is requested by a doctor. The thing is, wait times in my area are CRAZY. I’ve been waiting for an initial GP appointment for 4 months and still have more than a month and a half to wait. Is there an affordable telehealth service that will send an STD request to the testing center so that I can run it through my insurance card and hopefully pay less than $228?

Sorry if these are dumb questions, I don’t really understand how health insurance works.

Thank you!

Edit: to clarify, I don’t have symptoms. This is just for routine testing for being sexually active & dating. Thanks!

For brevity's sake, I have UHC. ABSOLUTELY HATE IT. I've been on the phone with these people for over 2 hours now because they can't answer a simple question. 99.99% of the time, my call gets routed overseas to someone in India. What usually happens after I explain the situation is: 1) they don't understand and waste time asking me to explain it over and over again, and eventually DROP the call (YES, THEY DISCONNECT), or 2) they transfer my call to a supervisor or manager who is supposedly better equipped to assist me, but their leadership is just as incompetent as they are.

Please advise. How do I get ahold of a US-based representative?

Hi everyone. As the title states, I’m at my wits end and don’t know what to do moving forward.

I’m currently 25 weeks pregnant and am high risk. Around 18 weeks, my husband changed jobs so our insurance changed to Imagine Health. Had never heard of them prior to this and now I’m beginning to see why. We pay almost $200 a week for this insurance and it has been USELESS. My current OB’s office informed me they don’t accept this insurance and if I wanted to continue care with them, I would have to be self pay.

I contact my insurance to get assistance with finding an OB who does accept my insurance, but that has been a complete bust. They have sent over lists with doctors who are retired, or truly do not accept my insurance. I have not been able to find a doctor that accepts this insurance. I didn’t want to go without care so I attended my OB appointment at 20 weeks for my anatomy scan, at which I was informed I would have to pay $3500 up front for the delivery fee (my doctor and I discussed a planned c section at 39 weeks so I can have my tubes removed). I paid them the money because they advised they would not see me for that appointment unless I had paid the $3500 in full.

At my last appointment last week, my doctor informed me I would need to register with the hospital to get the c section scheduled. I attempted to register last Friday however, one of their labor and delivery reps reached out advising that they don’t accept our insurance and that I would need to get with my provider’s office to schedule my c section at a facility where my insurance is accepted. When I spoke to my provider’s office, they advised that my doctor does not deliver at any other facility. When getting back to the hospital, they advised they wouldn’t be able to schedule me, even as self-pay (out of pocket).

What do I do? What are my options?? I’ve already paid $3500 for MY doctor to deliver my child so if I try to find an in-network hospital, that money will have been a complete waste. I’m at a loss and feel like I just keep running into road block after road block. Every time I try and call my insurance to get some sort of guidance, they tell me they’ll get back to me and then never do. I had a person through my insurance that I was emailing with, who was supposed to be assisting me, but she has since gone ghost on me and I haven’t heard from her in over 3 weeks at this point.

Time is of the essence and I just don’t know what to do at this point. I feel so stuck and lost.

I pay about 2k a month in premiums for my employer sponsored insurance. It includes my husband and myself. Zero deductible, 25k out of pocket max. If it was just me the cost would be ~300 a month. I've checked to see what he could get on the open market in California and it's about the same. I've ran the numbers if we get divorced and start filing single. His costs would be about $300 a month on open market. Should we divorce, feels like we would save money. Ffs.

I recently went to an in-network physical therapist, and I had asked for a cost estimate prior to the visit. They asked for my insurance details and got back to me with exact numbers for the cost of each visit before + after my deductible is met. After they submit the claim, my insurance is saying the "Patient Responsibility" is ~25% more than the estimate, and i now have outstanding bills from the physical therapist.

Why would the estimate with an in-network provider be inaccurate? I can understand it being wrong with an out-of-network provider (this happened to me at a dentist before), but I thought the whole point of an in-network provider was that there was a negotiated rate and a predictable cost? Is this normal, or am I missing something?

I recently had some health concerns come up, but I fear I won't be able to afford any appointments or treatment without insurance. I have never had insurance, and I am completely new to the concept. Unfortunately, as I am a student, I have to remain on my parents tax forms so I can receive financial aid. Is there anything I can do or do I need to wait until I am considered financially independent?

For some additional info, I have a part time job and live in Missouri. My income is below the taxable amount.

I was doing some research to see if I can have my insurance cover a glp-1 medication again, as I was covered in 2024 before policies got very restrictive and lost 60lbs, taking my BMI from obese to normal/healthy. I had to stop the rx when I switched insurance companies, and now I can’t get covered again. I’ve been able to use samples from my provider’s office for a couple of months and do take vyvanse, so those things help, but it is still a tough battle, made extra frustrating by knowing there is something that works but I can’t access it.

What I found was even if my employer does not cover any glp-1’s, I can basically do a request for formulae exception to my employer to have it covered. Has anyone tried this? It’s not exactly financially feasible or desirable to spend $200/mo on compounded options or pay out of pocket for the name brand. If I can’t get it covered, I’m willing to simply go without and try to stay on top of my weight without it.

I had Healthfirst Essential plan which got sadly defunded and I am no longer eligible so I needed to find a new one. I found another healthfirst plan but when I enrolled they said it doesn’t start until August 1st, but essential plan got booted June 30th. I find it really unfair that it worked out this way, leaving people with no insurance for a month.

Now, I am confused because they notified me to make a payment so I did. Via NY State of Health I received a message about said insurance that states “If you have a monthly premium, you will receive a bill from your health plan. You must pay the monthly premium to START and keep your coverage” just for it to not actually start until august 1st? it makes no sense to me and I’m incredibly frustrated as I had two important pre scheduled appointments this month that I now have to put off. Also, so why did I have to pay now??

I called the state and all they could do was put in a request to get my insurance to start sooner, but it can take up to two weeks to complete, so yeah currently have no type of coverage.

Can someone please explain if this is normal, if i should’ve gotten a head start on it? I was not made aware it would be like this so it sucks to have to figure it out like this on my own.

Hello, I just have a few questions that I’m hoping could be answered.

About 2 days ago I got into a solo car accident. I was driving about 60-65 mph down a highway and passed out at the wheel and crashed into a guard rail.

Before anyone asks, the passing out was due to a combination of dehydration, hunger, and sleep deprivation. It was also during a heat wave and it was about 115° F, and the AC in my car was not doing anything. Since the accident I’ve eaten, slept, and drank plenty of fluids, and have not felt any sort of symptoms of passing out since.

My question: My back and my neck are on fire now, which I am assuming is a delayed response from the accident. My lower back is in significant pain and any time I turn my head to the left I get a searing pain that goes down my neck into my shoulder blade on the right side.

I have been reading online that if I do go, I need my auto insurance information. Is this true? I have not filed an accident report because I am trying to avoid going through insurance to repair my car (I do not want rates to go up). But, if the out of pocket repair is too much, I, unfortunately have no choice but to go through insurance. I am still on my father’s car insurance plan and he’s been very stressed about the insurance rate going up.

I have Fidelis Medicaid through NY State. Is there any way I am able to get checked out without needing anything car related?

Thanks.

Assuming you have essentially free health insurance that covers everything like the NY Essential Plan 1 where you only have copays and no deductibles, what happens when you see a doctor and then you are recommended to get an MRI?

1. The doctor will write you a referral for the MRI after examining you and would most likely pick the MRI location for you correct? But you then have to confirm with billing that the place you are going to get an MRI accepts your insurance right? I know that seems to be the case for people who self pay for their ACA plan but what if it's a plan like the NY Essential Plan 1 which is essentially free except you have copay?
2. If you are pretty certain you are going to get an MRI or multiple MRI's, can you actually ask the doctor if you can get an MRI at a certain location? Of course for you to even suggest that, you need to have done the research before that this place accepts your health insurance for MRI right? Do doctors have any issue with you choosing which MRI location you choose? As long as it's the right machine and test, that doesn't matter? Of course there is the how soon can you book an MRI. So if you find a location on your own that has good reviews and good waiting times, you can suggest some locations or is that not good? Other reason would be if a location is closer to you.
3. I'm aware that if you self-pay for an MRI, those usually cost between $300-$650 most of the time at those lower cost self pay places. Average MRI cost I believe is probably $500 or so self pay. But if this is done in a a regular place, it will certainly be $2000 to $5000 or more right with self pay? Does anyone know if the self pay MRI locations founds on radiologyassist only take people who self pay? I had thought this was the case but then someone commented it would be pretty hard to do this as they don't think there is a large enough self pay market for them not to which sounds true. If that is the case, would that mean very few doctors schedule patients to those places even if patient health insurance covers it? So the majority of patients who do MRI's at those locations are self pay but still a decent percentage is from people with health insurance or not?
4. Assuming it's the same MRI machine, it shouldn't matter whichever MRI location right? I do know that the radiologist results will always be slightly different with the reports.
5. If you need to get multiple MRI's and don't want a long wait time, does it make sense to find any MRI location that does those specific tests if they have a shorter wait time? So imagine you need several MRI's and you find out that one of those self pay locations have a much shorter wait time than the better ones with better reviews, would it ever make sense to go to those self pay locations that your health insurance covers?

Background

* My goal is to get one of the popular weight loss injection medications, with my first choice being Zepbound. Unfortunately, my insurance does not cover Zepbound for weight management.
* However, I have been diagnosed with a severe case of sleep apnea after taking an in-home sleep test, for which I have been trying a CPAP for about a year. While it has reduced my AHI from 45 to 5 when I use it, I have trouble tolerating the way the mask feels on my face, so I can only wear it for 2-5 hours a night, averaging about 4 hours. I have already tried two different masks. I also currently have a BMI of 31.
* While Zepbound is not covered by my plan, Mounjaro is. I tried submitting a claim for Mounjaro through my doctor for weight loss, but while the doctor approved it, it was rejected because I do not have type 2 diabetes.
* I spoke with Optum customer service, and they told me I should try submitting a Formulary Exception Request through my doctor for Zepbound.

My Questions

1. If I submitted a Formulary Exception Request with all the proper paperwork, how likely would I be to get approved?
2. Armodafinil is covered through my plan for sleep apnea. Will I need to try this first before the insurance will consider letting me use Zepbound?
3. How long does the approval process usually take?
4. If I get denied, are there any further steps I could take?

Hey everyone, looking for some real, unvarnished advice from people actually in the industry. I’m 59, just got my Florida 2-14 (Life/Annuities) and 2-40 (Health) licenses, and I’ve already stepped face-first into a massive IMO/MLM trap. I need a serious reality check on finding a legitimate path forward.

To give you a quick background: I am a pure closer. I did mortgages as a loan originator up until the 2008 crash, then transitioned into hardcore, high-ticket kitchen table sales (residential water treatment systems) until 2020. I was a consistent $95k+ earner specializing in the one-call close. When COVID hit, I had to walk away from sales to become a full-time, 24/7 caregiver for my 90-year-old mother who had advanced Alzheimer's. I stayed by her side until she passed away.

Now I'm getting back on my feet and decided insurance was the best place to deploy my skills. Because of my age and some lifestyle changes, I really don't want to be chained to an office permanently anymore. A couple of days a week for hybrid/training is fine, but I’m looking for a remote or hybrid setup.

Here is my dilemma: I signed up with an agency and after three one-on-one coachings, the red flags are screaming.

I just discovered the “free lead system" (the reason I signed up) requires me to have 5 active contracts in place. Or I could just buy packs of 20 leads for $700 a pop. Oddly they are training me to sell complex IULs and told me to come back with a list of 20 friends and family members. They want a 20-year-old "upline trainer" to get on Zoom with me, call my personal network for "practice pitches," and take a 50/50 split of any commission.

Look, I could outsell this kid in my sleep if I just know the logistics of the process. I am absolutely not burning my personal network or begging my family for business just to feed an upline.

I am not a prospector, and I don't have a local network to exploit. But if you put a warm lead or an inbound live-transfer in front of me, I will close it.

Where do guys like me actually belong in today's market? Are there legitimate corporate W-2 or high-support 1099 roles that actually provide a solid lead flow (like Medicare live-transfers or captive carriers) rather than making you buy leads or recruit your friends? I have my licenses and E&O insurance ready to go. I just need a real direction.

Appreciate any insight you guys can give me.

Back in January I did a video call with a doctor because I had a swollen cheek/gums due to a tooth infection. I didn’t have a car and didn’t have insurance so I paid $140 for the service. No problem because I was in pain and I was able to get medication for it. Problem resolved.

Fast forward to June, my mom tells me that while she was renewing her and my sisters insurance she lets me know that I somehow still have insurance as long as I send in proper documents from my employment. I tried to do it online because I was told I could but my information was not existent. To be honest, I didn’t care anymore and didn’t bother to call (depression, unemployed).

Three weeks later my mom gets her new insurance IDs and somehow I get one too. I’m confused but again due to my mental state I ignore it. Same week I get an email saying i am being refunded for the service I had back in January. I go to the app to make sure it’s real and it is. I don’t question it because again I’m unemployed and $140 is alot for me right now.

Now this week I get another email saying I owe $380 for the service!! I cannot call because I got the email yesterday and everything was closed and need to wait til tomorrow but if anyone has any idea what this could mean, that’d be great!

Primary insurance is contracted with American Specialty Health (ASH) to process specialized services like PT. Primary insurance pays on the PT claim but provider does not receive the full amount paid by primary due to involvement of ASH.

For COB purposes, should the amount paid by primary or the net received by provider be reported to secondary for the “other carriers paid” amount? The difference in those 2 numbers is affecting patient responsibility.

I don’t trust the secondary EOB because provider never sent secondary the primary EOB that shows what primary actually paid. I have sent secondary the primary EOB

Essentially the money that ASH intercepted is being passed to patient responsibility. Despite many hours on the phone with primary, secondary, and billing, I think it’s time for that magical conference call

Hi, I am 27 M and im trying to reach out to any individuals who know better than I. As of last November I haven't been enrolled in insurance through my company and haven't had any for the year. In a few months I will be eligible for enrollment. However in the past month I have noticed some things popping up that make me concerned and genuinely wish to get seen. What kind of resources could I look into that might help me medically until I can get insurance? P.S. my reasoning for the concern included pins and needles in my fingertips and toes and random spots with some numbness/dullness in my top left leg and left jaw/back of neck.

Thank you for any that can help

I have BCBTX insurance and I want to compare cost for specific cpt code, but cust serv can not help me. they give me some of the providers though. their website is horrible. They have cost Estimates for few, but they are not correct. The sad thing is online cost estimator does not accept cpt codes??!!! I have enter a name ??!!! How can I get all the cost from providers in my area for a specific cpt code?

I signed up for Medicare part B in October thinking I would retire at the end of the year. As it happened I still have not retired and I am covered by my employer'group plan which includes drug coverage .

I picked up a Medigap policy in December knowing that I had to get this policy within a few months of getting Part B

When I signed up for Part B I sent Medicare a statement of continuous coverage which Medicare accepted.

I also signed up for a Part D plan through Humana which went into effect in January. I missed and just found a letter from Humana stating that I did not have continuous coverage for Drugs since 2016 and that I needed to send them a letter showing coverage by January 9, 2026. I literally just found this in a pile of paperwork in my kitchen. Yes shame on me for missing the letter.

I don't think that Humana is charging me a premium at this moment. Can I submit the statement of coverage at this late date to avoid the penalty?

Doesn't the statement I submitted in October cover the Part B letter?..

Any advice is appreciated.

Thanks

so I just got kicked off my parents Tricare insurance and my college requires me to have insurance. For some reason I don’t qualify for Virginia Medicaid even though my income is well below the threshold. I’m young, I’m fit, I have no ongoing conditions and am completely unmedicated with therefore no reason to see a Doctor for anything more than the absolute minimum checkups. Lucky me. I need one year of the absolute cheapest healthcare I can find. just one year before I finish my degree and can get an actual job with healthcare. do any of you have suggestions?