r/HealthInsurance

I got a letter today stating that I need to reenroll on marketplace because my current plan isn't being offered again, twice.

Turns out, the commission making representative signed me back up in June to make commission and another rep, who ive never spoke to, used my info to sign me back up again in September. I had two policies, both fraudulent amd I know im not the only one. These people don't care that I would have had to pay all that back with next year's taxes. If you are a rep, don't do this. I will be calling Monday morning to make sure as many people know about this as possible. They should be sued.

I'm hoping someone here has dealt with something similar or can point me in the right direction.

I purchased a short-term medical insurance policy that became effective January 1, 2026. In December 2025, I had a routine OB/GYN appointment where I discussed irregular/heavy periods and cramping. My doctor documented a normal pelvic examination, suspected possible fibroids or polyps, and ordered further testing.

After my insurance became effective, additional testing identified polyps and fibroids, and I ultimately underwent a medically necessary hysterectomy.

My insurance company denied the related claims as pre-existing because I had reported menstrual symptoms before coverage began.

I've submitted multiple appeal letters, obtained a written statement from my treating physician, and filed a formal complaint with the Indiana Department of Insurance. My physician has also sent her supporting statement directly to the insurer.

The communication has been incredibly frustrating. I haven't received a response to my second-level appeal, and when I call the general claims department, representatives often cannot even locate the medical records that the company says it reviewed.

I've contacted numerous attorneys in my area, but most only handle personal injury cases. I haven't been able to find someone willing to review an individual health-insurance coverage dispute.

Has anyone successfully challenged a pre-existing-condition denial under a short-term medical policy? What helped?

I'm also looking for recommendations for an Indiana attorney who represents policyholders in health-insurance coverage disputes, insurance contract litigation, or insurance bad-faith matters.

I'm not looking for someone to guarantee an outcome. I would simply like a qualified attorney to review my policy and documentation and tell me whether I have a viable case.

Any firsthand experiences, attorney referrals, or suggestions would be greatly appreciated.

Hi all,

I went to an ENT and that doctor referred me to another place to have an allergy test then came back with the result.

I called that place (and many similar places), the code for the specific test only came up $7 in BCMA tool but all of these places also charge a doctor's visit which usually cost > $100.

What I don't understand is why do I have to pay for the doctor's visit if I just want a test. I think it should be:

* I visit the ENT - paid doctor's visit once and a nasal endoscopy

* Now I just need a test in another place, I don't need to see a doctor at that place.

* Then I visit the first doctor again and possibly pay for another visit.

I have no reason to see the doctor if I just want a test, they don't know about my nasal endoscopy or anything about the previous visit. The most they do is look at the test result and conclude sth. The first doctor will combine that result and whatever he found out in the first visit to diagnose.

So questions:

* Is it normal to get charged for doctor's visit even if you just want a test?

* Anyway to filter out places that just do test without forcing the doctor's visit as well?

* Usually if you visit the first doctor again after the test result, do you pay for another doctor's visit with the first doctor?

* Can I ask the first doctor to email me all the results including the nasal endoscopy so I can visit the second doctor for the test and give them all of that and won't need to come back to the first?

Thank you!

BC MA cost estimator/help line is not helpful. It's always "depending on the provider" - if they bill under the doctor or the facility, if they charge you a doctor's visit or not... Feels like they should have all of that in place.

They can't just give me a place that does X for Y amount.

Trying to figure out where to start since I already got slapped with a $5k for the ultra sound to get diagnosed.

I understand layoffs qualify you. How about quiting?

Last year, when I was insured, I got an ultrasound at the hospital. Was billed a copay for $80, paid it, great. A year later, I get a surprise bill for $600. Apparently they started billing my insurance two months after my visit, with no response from my insurance. In the bill I see 11 attempts, of three different medical codes, all ignored. Starting at $134, then $300, now $600. Finally, they're billing me.

My question is, how do I dispute this? I was insured. I was not made aware of my insurer's lack of response even one time in the whole year since I had treatment. Now due to their lack of response, it's my responsibility to pay?

Who do I contact first, what do I even say?

I just started Medicare this month with Part A, B, D (Wellcare Value Script) and Medigap with Blue Shield. I'm in California. Before I picked Wellcare Value Script, I put my medications into their pricing tool, and I could see that half my meds were reasonably priced at one pharmacy, and half were reasonably priced at a different pharmacy. However, I am stumped as to how to now price my meds and have my doctors send to the pharmacy. For one thing, one of my meds comes back as can't give me a price (looks like a Tier 4!) I can pick a "primary pharmacy". Does that matter? I am a little confused, and considering trying another plan at open enrollment. Any thoughts from others here in CA with this plan?

Hi everyone:
(FL)
I am experiencing some billing issues with my provider, and hopefully someone might be able to help me with resolving them. Any advice is helpful, thank you in advance.

I changed insurances April 2025 and my provider accidentally sent it to the old insurance company (even though I gave them the new information at time of visit).
They sent the claim to the old insurance company July 2025, and the insurance company denied the claim October 2025.

They then resubmitted to my current insurance company Feb. 2026 who originally denied the claim for failing to file timely, but then the provider resubmitted May 2026 and the claim was processed.

June 2026, I receive a letter in the mail stating that I owe $275 for this visit, which is a lot higher than the other visits, so I call them to find out why the balance is much higher and obtain a copy of the medical codes and billing statements. Essentially, for this one visit, they used a code that they have never used my 5 years there, and I believe does not match the services provided. From what I gather, this code is for visits 30-45 minutes long, but the visits are always 15-30 minutes, which is the code that is normally used.

I asked the provider via email to review the codes for this visit as I believe it’s incorrect and they let me know that the process takes about 7 days. That time goes by, and I send a follow up to check on the status, and they tell me they need another week. This pattern continues for 6 weeks.

I genuinely believe that this bill is incorrect, and I have tried reaching out to the provider multiple times to get this resolved, so I am frustrated that the provider just sent the bill to collections. I already disputed with collector and told them the situation/ wrote an email documenting the call.

Does anyone know what I can do in this case? I feel like I should report this provider for misusing a collection agency for a bill that they (1) took their time in submitting the claim and (2) were requested to verify the medical codes numerous times via email/phone call.

I am willing to pay what I owe, but nothing more than that.

Has anyone ever looked into this exception?

Tier 1 therapy is a $20 copay and tier 2 is a $120 copay. The difference obviously is insane for something that is being done weekly.

Additionally, 6 months for an adult maybe not a big deal but 6 months for a 3 year old is a lot! That would set him back even more significantly.

Any tips on getting an exception approved if it would be possible in this scenario?

So this is my senior year and l've waived the student insurance every year, but this fall deadline I completely missed. I've been working a lot more and this semester of nursing school has me so paralyzed by everyday being work or clinical. I've also just been struggling mentally and small things that take 5-10 minutes end up feeling like I have all the time in the world when there's an exam coming up or I'm trying to stop ruminating on social interactions I have daily. I started seeing a therapist for the first time in my life because I'm really trying to motivate myself to stay on track with everything and l've been having really bad anxiety that has been getting of my ability to do things like just talking to people around me. Anyways the thing I never miss I ended up missing after telling myself "I have time, this is just more important" until it left my mind. I waited until the very end and then the deadline and my exam were on the same day and it just left my brain.

I'm honestly just really mad and disappointed in myself because I work super hard at my job to save money and I have Medicaid so a 3k charge right now would be devastating, even if I pay it through loans later on and become more financially stable in the future. But right now I just don't know what to do. I wish I had just waived it the minute the waiver opened but I didn't. I sent an email 2 days after the deadline closed just explaining my situation but I just don't know any next steps I could take but also how to not beat myself up even more about it because that's been the worst part of this whole thing.

Hello Everyone! I am a travel nurse who is moving agencies. Right now I pay $120 a week for health insurance with CC. My next contract with MS does not start until a month after my last day. I need health insurance bridge recommendations plz! Preferably a nationally accepted insurance plan. I'm from Texas traveling to Arizona. Any advice or recommendations appreciated!

If you are operating an off road vehicle on a public road (an illegal act) and are injured, will your medical insurance cover you?

Would it matter who was at fault if another vehicle was involved?

Does the state or locality matter?

Hello all,

from what I've heard Heather Faulkner accepts various insurance companies,but I live in Alabama and will be kicked off of Medicaid once I turn 19. From what I've seen on the MyChart estimate (I know it is subject to change) that if I am to pay out of pocket w/o insurance then it should be around $5,200. From what I've read through facebook groups/this group is that my out of pocket cost would be less if I use insurance; however, how will this work if I do not know much about healthinsurance.gov (I'm afraid they will not cover it and how long I would need to be on an insurance plan before I need a letter from them to see if they will cover the surgery).

If anyone is in the same boat then I would really appreciate some insight on the process!

Thanks

Plan A:

COST PER MONTH- $200

Deductible- $1500

Max out of pocket- $8500

What I pay after deductible- 20%

Copay- $20-40

Plan B:

COST PER MONTH- $70

Deductible- $2750

Max out of pocket- $6850

What I pay after deductible- 25%

Copay- $35-75

I foresee lots of medical issues for myself in the near future. Which would save money?

my s/o has been on-and-off of mat for 6+ years. he was on medicaid for the past few years and transitioned from suboxone to brixadi seamlessly. he had no relapses on brixadi, his mental health stabilized and he was able to work on reparative therapies beyond managing day-to-day cravings.

his employer adopted a kaiser plan that isn’t truly a kaiser plan but is actually western health advantage, which is contracted with optumrx. despite us living literally 5 blocks away from a kaiser pharmacy, and despite his insurance being “kaiser,” he is required to manage his prescriptions using optum’s formulary and membership services only.

his brixadi was no longer covered and he was forced to move backwards to tier 1 generic bupe/naloxone sublingual strips (not even true suboxone) and has been sincerely struggling since, to the point of it affecting his work, his personal life, his physical and mental wellness. his prescriber has been trying to submit a prior authorization but i am seeing now that brixadi actually requires and additional prescription exemption due to brixadi being a specialty drug (in that it has a required refrigeration temperature).

would he have an easier time trying to get a prior authorization for sublocade? they are both the tier 3 (suboxone is tier 1) but sublocade does’t have any additional prescribing indicators like brixadi.

or would it be easier to transition to a tier 2 medication, use that for a trial period and then request a prior authorization for a tier 3? what is the more likely barrier: skipping from a tier 1 to a tier 3, or trying to get both a prior authorization and an exemption with a specialty medication?

he has been at this for months.

i feel so bad for him. his prescriber is ideal option. we are in washington state.

I was wondering if there were any health insurance options for international student that have a good cover for preventative care.

I’ve been stable on my long acting pain medication for years. My insurance company has always covered it. I got a letter in May stating that it would be non formulary starting in July .in the letter they suggested another medication. My drs office put in the prior authorization and it got denied because I didn’t meet the criteria of being on that medication continuously (I’ve been on my other med continuously so why would I be on this med) the other criteria was I needed to trial instant release for four weeks. That’s not possible going from extended release to instant release. It’s not safe. My drs office put in a prior authorization to continue my regular medication, it was denied twice. I never received a written denial for two of the denials. The drs office put in for an urgent appeal as being without the medication could be dangerous for my health. They denied the urgent appeal based on them saying it wouldn’t be dangerous to my health. This whole process has been extremely anxiety provoking and it will be six weeks once this internal appeal is complete. I also had to pay $1250 for my prescription while this is happening. I’m thinking of asking for a peer to peer review and an external independent review. Are these avenues more successful or am I wasting my time. This is not right. What are we paying our insurance companies for if they are working against their members. Any suggestions are appreciated. Thank you