r/HealthInsurance

Like the title says: can I cancel a membership that seems to have been added when I enrolled in the Marketplace without canceling my insurance? I'm not asking about getting refunded.

Familiar story. New to Marketplace insurance. Signed up via a broker for Blue Cross, signed an authorization (this turns out to be the authorization for the "membership"), was told the premium would be ~$104, and paid $99 with a credit card (thought I was prepaying the first month of premiums). Everything was fine after that, especially when the premium was only $4.91 a month.

Then I see I'm getting recurring monthly $99 charges from Premier Health Solutions for NextStep Health Value 2.0. The product description expressly says this is a "membership" ("Thank you for enrolling in a membership program through us") and that "NextStep Health is not insurance and does not satisfy ACA minimum essential coverage" and that "I understand that when I cancel my automatic payments, all memberships I am enrolled in will also be cancelled."

I called my insurance to ask about this; they said Premier Health Solutions had nothing to do with them and indicated I could cancel NextStep and my insurance would not notice. But when I called the brokerage that handled my enrollment, I was told that canceling NextStep would cancel my "major insurance" as well (and that I'd be ineligible for Marketplace insurance, without a QLE, until November). They made it sound like a bundle (the insurance and the membership), with the former contingent on the latter.

I'm not interested here about possible broker misrepresentation, me more closely reading authorizations, or track auto-charges on my credit card. I just want to know: can I cancel the membership and not cancel my insurance? (So far, I'd say everything suggests yes, but I'm not certain enough yet, so I'm crowd-sourcing Reddit's knowledge and experience).

1. Could they have sold me a policy contingent on maintaining membership in Premier? I doubt that's legal or common, but it also wasn't disclosed to me as such. (I know I can complain to the State, and I will, but in the meantime, can I cancel the membership?) This is the only kind of condition I can imagine under which the broker could actually cancel my insurance. However, it looks more like they're just trying to intimidate and bluff me into leaving things as is.
2. Who controls, owns, or manages my policy's continuance? Me, Blue Cross, or the broker? (I'm in good standing on my premiums.) If they have zero control over any of this, then I can cancel without trouble.
3. The wording on the form says "memberships" will be cancelled; I don't have memberships in insurance, only Premier. If "memberships" only means Premier, I can cancel without risk to my insurance.
4. Would there be a line item in my insurance policy indicating Premier as some kind of rider or supplement? (I'm writing this before digging up the policy, but I think the answer is "there's no such supplement in my policy anyway.")
5. There's also no billing from Blue Cross indicating Premier on their premium invoices. Premier hasn't invoiced me; they just run the card. They don't send a receipt either.
6. Also, isn't it abnormal to "pre-charge" premiums before insurance starts? But that's what they did when they ran my card in mid-January. Looks more like they were paying my first month of membership.
7. What am I missing?

In particular, it'd really be helpful to hear from someone who got "enrolled" like this by these guys (or someone analogous) and cancelled their membership. Did it mess up your insurance or not?

Thanks in advance.

I made an appointment to see a cardiologist who was in my insurance network. The doctor is affiliated with the hospital that is also in network.

He prescribed an outpatient procedure and a CT scan.

The insurance company tells me the radiology dept and the surgical department where I was going to have the procedure are both out of network even though they are at the hospital where the doctor works.

TL/DR: How can a doctor and his affiliated hospital be in network but departments at the affiliated hospital be out of network. It makes no sense to me.

I make 3384/month gross, however, after taxes, it is about 2720/month.
My car payment is $375 and Insurance is $165
Phone is $30 and food/supplies is $300~
Gas is running me about $150 monthly right now due to work commute.
I zelle my Mom $850 every month to be able to live there.

That leaves me with about $850 left over give or take. I've been paying $200 monthly out of pocket through TelyRX just to get Inhalers, and I'm not even getting the controller I need, so I'm just getting the rescue inhaler. Can't get blood work done, can't get anything done. Urgent Care wants me to pay $1,000+ for a visit since I'm not insured, and ER is 3HR waits, and said I'll be billed out of pocket.

I don't qualify for medical, or covered California, or any of the benefitsCal. My job provides health care, however, it cost $410/month, and I looked into my CoPays which would be $90 a visit, and my inhaler deductable with that plan they offer will run me $150/month. It is a terrible health plan.

I've been tryna save some money so I can continue my education but this world just seems to be pinned against me not allowing me that room to grow. I called them and they don't seem to care they just keep telling me I don't qualfiy, one lady even seemed to be offended I sought the application. I went in person they won't help me, and the phone calls are all pointless. I already appealed and got rejected again. Covered Cali doesn't qualfiy for me because it isn't an urgent life event and it is not within the enrollment window.

Quite frankly I'm at the point where I'm just gonna quit my job and get EBT/Medical that way because this is beyond confusing to me. I don't wanna quit, I really like my job, and I wanna keep working because it'll help my resume. But I'm at the point where that might be my only viable option.

I have to pay the $850 to my Mom or she'll be forced to replace me with a tenant. Sounds harsh but my Mom needs the money to and I been trying hard to keep that money coming in.

These little things also keep pushing me down which is why it's unfair I'm expected to go in debt for medical insurance. Can't even afford to get my cavity fixed right now, nor teeth cleaning. Yet these people keep telling me I can afford health coverage. :(

Edit: They offer Blue Shield Gold health plan $0 deductable but it is $610 monthly.

Basically I had a bad allergic reaction to beestings. I started getting hot/cold flashes projectile vomiting and feeling a distinct sense of “impending doom” so called 911. Paramedics said I was stable recommended urgent care and let me sign out AMA.

Husband drove me to urgent care where we were ignored for 30min until a PA rushed in and said my HR was 150 BP 90/60 and she’d called 911 to transfer me to the ER. I was literally not allowed to leave she said she couldn’t let me husband drive me.

My husband BEAT THE AMBULANCE TO THEBHOSPITAL. And now they’re saying it’s out of network and I owe $2700? When I literally had no choice in the matter and it was a medical emergency? I thought the no surprises act protects people in these situations?

21M. Long story short I’ve been struggling with breathing for the past year and some change and developed Asthma. All due to Nasal Polyps. I went to a ENT doctor who diagnosed the problem, got me started on Tezspire, and did my surgery to remove most of the Polyps. After the first monthly dose of Tezspire and the surgery I could smell COLORS. Life was amazing.

But insurance wouldn’t approve a second dose. They wanted to switch to an alternative like Dupixent, which I did and they still wouldn’t cover it. Said I needed to first cover my deductible/OOP (my out of pocket is the same as my deductible with my insurance) of $6000 before they cover my medicine.

I was wondering, if I went to the hospital right now and just told them a bunch of shit just to rack up a medical bill of $6000+ and it was billed to insurance who left me with the 6000 to cover wouldn’t that be me essentially fulfilling my deductible? Would I have to really pay that 6k before it’s seen as me fulfilling my deductible rather than just having it billed out to me? Is this feasible?

I’m desperate here. I haven’t been to smell or anything for that year. I’m so happy now. I can finally go back to the gym without dying from coughing

I’ve been dealing with an emergency ambulance bill for almost 2 years now and honestly I finally understand why people say the U.S. healthcare system is broken.

Back in 2024, police called an ambulance for me during an emergency situation in California. I had zero ability to choose the provider. The ride itself was maybe 10-15 minutes.

AMR billed me $4,220.

At first, Cigna processed it as out-of-network and only paid around $215, leaving me with a $4,004 balance.

I kept calling both sides because this made no sense to me. It was an emergency ambulance transport. Eventually Cigna agreed and said this should be treated as in-network emergency services, and estimated my responsibility should only be around $734.

But then things got weird.

AMR kept telling me they were “working hard” with Cigna on my behalf. Then once Cigna actually agreed to reprocess the claim, I was told AMR refused the in-network arrangement because they didn’t accept the payment amount.

Meanwhile AMR repeatedly pressured me to accept a payment plan.

They kept telling me:

• interest would increase
• the account could go to collections
• it would become more expensive later

The tone was always very polite and soft, but looking back, I honestly felt pressured and threatened into accepting the debt before the insurance dispute was even resolved.

The craziest part:
my AMR statement literally says:
“AB716 - Balance Billing - $0.00”

Which means they clearly know California has protections related to emergency ambulance balance billing.

I finally filed a complaint with California DMHC today.

Honestly, if I didn’t have the time, English ability, and energy to spend hours researching laws, calling insurance, calling AMR, and filing complaints, I probably would’ve just paid out of fear.

I can’t stop thinking about how many elderly people or vulnerable patients get pressured into paying bills they may not even legally owe.

I had an MRI 3 months ago that cost around 760 after all was said and done. I had a follow-up MRI and I just found out my share is 3000. They are different codes but everything was the same, even the original costs are the same. I filed an appeal with Atnea but im worried it's not going to work. Do you think I have a chance?

new account to ask the question !! if im im the wrong place im sorry. i grew up poor and didn't go to the dentist much. i also struggled to take good care of my teeth as a teenager and now i'm afraid its coming back to bite me. i would like to go to the dentist and i'm wondering if its a good idea to get dental insurance first? i'm not sure what i'd need done and i don't want to be totally financially ruined by not having insurance if there's a serious problem, but i'm also not sure what company or type of insurance would be good for me? i don't work enough to get insurance through my work either so it can't be that.

Medicare transportation cost to see a doctor in rural states can be very high, Should Medicare adjust their coverage ?

After my colonoscopy/endoscopy procedures, I got two bills, I had already pre-paid an amount before the procedures because they told me that would be the total. Now, I got a random anesthesia bill and a bill from the hospital. The bill from the hospital is for charges for the use of a plastic irrigation bottle (36.75) and the use of metal snaremaster to remove polyps (109.20). I added the bills down below. In addition I was told that the colonoscopy procedure was going to be free, but now I have to pay for anesthesia and the snaremaster used to remove my polyps. Now, for the second bill, I got it from an anesthesia group, and that one is $378.45 and apparently my insurance covered some of it. Is there any way that I can reduce these costs? I was under the impression that it would basically be only the pre-paid amount, the lady at the hospital supposedly even gave me a discount of $200. Also more info, I finished paying my deductible amount when I paid the pre-paid amount and was told that everything after that would be 70%/20%. I can disclose my insurance if needed.

Bill for hospital

Itemized bill without the two things I have to pay for

same bill from hospital except this is from my portal

same bill from hospital except this is from my portal

Anesthesia bill

I have an Anthem HMO plan that started last month. First time with my own insurance so I have questions. So far, none of my appointments have shown up on my account or toward my deductible. I figured there is probably a delay, especially if the doctor’s office doesn’t bill insurance immediately.

My question is, what happens when I pay more than the deductible? As an example, let’s say my therapy appointments cost $150 a session and my deductible is $250. These are made up rates, I wish they were those numbers lol. If I’ve gone to two sessions and paid the therapist $300, do I get that $50 back from insurance? Or is it not as soon as you hit $250, it’s after the appointment where you hit $250?

And when I go in next time, they shouldn’t charge me, right? Or will I be charged until these things show up in my Anthem account?

I accidentally mistyped my email address to create a new Oscar account, what should I do in this situation? Please help me out if anyone can see this post

I’m a healthy young person who has leftover HSA from my previous employer. My current employer insurance will cost me $400-500 per month for myself as a single person. I’d much rather just pay for my appointments/medication etc. out of pocket. However, I run into the problem if something catastrophic were to happen to me. Insurance is very confusing to me, so I thought I’d come ask to see if there are any other options for me to pursue. I’ve also heard mixed things about marketplace but I’m considering talking to a broker to help find me an alternative plan, but again I’m also confused about that as well and I’m afraid of getting screwed over. Let me know! Thank you!
Note: I’m between the age 26-35, I live in Colorado and my income 55k from my employer (I sometimes get extra income from gig work though)

EDIT: it costs $218.24 biweekly
For more context, I was laid off last November. And didn’t start this new job until beginning of March. Between January 1 til now I made an extra 3,480 in gig work on top of my 55k salary I started in March and also some unemployment money as well.

TL;DR Need help finding PT thats local and can take Florida Blue myBlue HMO. Website shows 0 providers in 98 miles. Customer service was no help. I’m in Southwest Florida. MRI requires PT first.

Original post:

Hey everyone. I injured my back about a month ago and tried for about three weeks to recover and couldn’t improve. I went to the local urgent care who told me it was just a muscle problem, gave me muscle relaxers and anti-inflammatory drugs and a referral to PT. Ok great.

Three days later I go to my sister’s college graduation 4 hours away, it was a pain to get to and struggled my entire time there. I get home 3 days later and my left arm suddenly goes numb. Alarmed, I go straight to the ER. They do CT of lumbar and cervical, give me an IV drip, more anti-inflammatory drugs and more muscle relaxants. Now I have a referral to a neurosurgeon.

Sounds great, right? Well, now comes the insurance. First, insurance denied both referrals because they weren’t done by my GP. So I go to my GP and get referred again to the neurosurgeon and PT. Great. Go to schedule PT, then get a call back 2 days later saying PT done by the hospital group is considered “hospital“ and subjected to 50% coinsurance on EVERY VISIT. So $300 for consult, $294 for every subsequent visit until I hit OOP max. They tell me I’d be better off to find a “free standing” place for PT as the cost share would be lower. Great again.

They can’t provide any providers and tell me I’m on my own. I call Florida Blue for a list, and due to the language barrier, the CSR can’t give a list and tells me to try online. Awesome. I go online, and there’s no phys therapists in 20 miles, or 50 miles, or 75 miles. There‘s only one provider 98.6 miles away listed. That‘s way too far.

So I call the neurosurgeon office, they tell me they won’t schedule until I’ve had an MRI with results in hand and to go back to primary care for the order. He sends off the order, and boom MRI declined because need PT. The same PT I can’t get covered at all anywhere for 98 miles.

I’m stuck and need help.

My husband and I just got married and need to get health insurance. We make about $6,000 after taxes a month so will not qualify for any benefits but still do not want to pay 2k a month in insurance. Both of our jobs don’t have plans. We both are healthy no problems. I am trying to get pregnant in the next year tho so I need coverage. We are from Kentucky if that helps any. TIA

Edit: My deductible is $6500 and I’ve checked all the discount sites expect for Mark Cuban, I will be looking into that one! I spoke with my doctors and my HR rep and they both are telling me to get started on the HSA, I didn’t think to sign up for that when I started because I never needed it in the past and I’m working a real temporary job while I get through grad school and only bring home about $2k a month. But hey, if I’m gonna be spending the money anyway I might as well. I appreciate all of your advice, this is not a very pleasant reality for a sick person and I’m really struggling navigating my options on my own. My parents aren’t around anymore and all my friends are still on their parents insurance so this is all very new to me with very little real world resources. I really do appreciate your willingness to respond and stepping up to help a stranger 🙂

I just started working with a new employer that has a high deductible plan and none of my previous medications are covered. I guess I can’t really say that though because they are covered, the copay just goes straight to the deductible so I’d be paying over $2000 a month for 5 medications that cost me a total of $35 a month on my insurance through my previous employer. I do not know what to do, some of these are keeping me alive and there aren’t any alternatives available. The generic costs aren’t any different either. I’ve exhausted all discounts and alternatives I can so it’s either I pay the 2 grand, which isn’t an option because I don’t even have that in disposable income after bills, or I stop taking them and risk losing my livelihood because they’re the only thing keeping me from having seizures or dying in my sleep. Has anyone else had this and found alternatives? I’d consider getting insurance outside of my employer but I don’t think I can because I’m required to be on this plan if I’m unmarried.

QUEST DID ADDITIONAL BLOOD WORK FOR PRENATAL on top of my doctor's orders.

Bill is now $1,300 dollars insurance won't cover because it was not authorized.

Does anyone have a contact for Quest like direct email or mailing address? I keep trying and get genetic ones and even more generic responses.

I need to discuss with someone as this whole ordeal was strange and felt like an intentional money grab

Additional info

She the (phlebotomist) asked about testing is said ok because I was there for doctor orders of genetic baby testing.

I got a call days later saying it might be expensive and I can cancel it I said how much the lady ran the numbers and said “zero dollars” she didn't ask or mention anything about an auth for these random additional that quest choose to do

So the lab work my doctor actually ordered was in network and fully covered

Insurance said they would cover this too but need auth

Doctor won't write anauthorization because they didn't order it

My son has been approved for SSI/SSDI which leaves just me needing insurance.

We were covered on the marketplace for 369/mo with a 400/800 deductible.

Removing him and increasing household income the plan has changed to $891/mo for only me with 5000/10000 deductible!

This will take 1/3 of my take home pay. And now I would have to pay the first 5k for it to kick in.

I'm just sick! I was told because household income increased and removing him caused this change. (My spouse is now on SSDI so add that to household income. My son is 21 and gets a small amount of SSDI-so that must be counted.)

The change is happening in June. I am at the point of cutting my hours and income- NOW.

I am told by removing him from the policy due to his approval for SSDI/SSI is not a qualifying event.

What options are there? (Besides cutting hours and making less money?)

TIA