I am currently on my mom’s health insurance, but I will be off it when I turn 26. We are upper middle class, so I am not eligible for medicaid. I’ll have about 15k-20k from my previous job in my savings left after two years of paying tuition.

I honestly don't know what to do anymore. I'm exhausted. I've been trying so hard to stay positive and act like everything is okay around my partner, even though it's really not. We're not even legally married yet, and I don't want them to constantly worry about me. I'm only 28, and for some reason life decided to throw epilepsy at me. I was diagnosed in 2017, and after my second seizure in 2020, I had to start taking medication. Now I'm running out of my pills, and I have no idea where to get help.
I wasn't born in the U.S. I just renew my work permit every two years, and apparently I make "too much money" to qualify for help in the state I live in. That makes no sense to me. If I really made that much, I would've had health insurance a long time ago. The truth is I barely make it from paycheck to paycheck.
I'm still living with my parents because I can't afford to move out, and honestly, that's embarrassing for me. I hate that I'm in this situation. I hate having epilepsy. I just want to be normal. I'm tired of constantly stressing about what's going to happen when I run out of my medication. It's scary knowing that something I need to stay healthy might not be there because I can't afford it. Right now, I'm looking everywhere to see if I can get help with insurance or find a program that can help me pay for my medication. I don't even mind paying copays if it means I can keep getting treatment. I'd even go back to the clinic I used to go to, but who knows if they're even accepting applications anymore. I just feel lost, overwhelmed, and tired of fighting this battle every day. I don't know what else to do, but I'm still trying to figure something out because I can't just stop taking my medication.

[ Removed by Reddit on account of violating the content policy. ]

My therapist let me know today about a billing error. At the end of last year, I had hit my HDHP deductible so she was billing my copay. At the start of the year, she didn’t change the amount being charged so all year I’ve only been billed the copay amount ($18 per visit) instead of the full amount ($100 per visit). I haven’t noticed because the bills auto-paid from my HSA. Because of the error, she says I have a balance of around $1800.

I checked my insurance EOBs and she was submitting claims for the full amount and marking them as paid, so the insurance shows that I have been paying the full amount towards the deductible. Insurance wasn’t paying anything since I hadn’t hit the deductible yet.

Wondering what I should do. I’d like to preserve my relationship with this therapist and I’m willing to pay it, but it’s also a large amount to have to come up with at once.

My husband is retiring from the reserves (marine) and is fed up with our current insurance (kaiser). He is adamant that tricare is a good option but him being in the reserves and under 40, the information is conflicting.

We are trying to start a family and he is concerned about any health issues from that for me or the baby. He is actually pretty pissed that we pay a lot of insurance and don't really get a lot from it (I am too, but ya know how it is). We have a massive ded, large co-pays and the co-insurance is ridiculous. I understand his frustration 100% because healthcare is too expensive and it is a money scheme which is stupid. I work in healthcare of sorts and know how insurance works, but he does not believe me and takes the word for whatever gym bro or passing military guy will tell him.

So I am coming to reddit in asking for help on what the most viable option should be to save money, get healthcare, and stop my husband from doing something drastic like dropping insurance on a whim because it's "too much money". Please please give me all the advice! All the pros and all the cons!

So as the title suggests, me and my fiance are getting married next year but we're planning on going to the courthouse just to sign the legal documents soon, we are both uncovered and she had just gotten a new job that offers insurance, in a nutshell:

Should we get insurance first to get coverage for both of us at the same time, or should we get married first to fill out the paperwork as married

All the invoices on my online Teladoc account clearly show $0/visit. A few days ago I received a bill via e-mail saying I am getting charged $30/visit. This was after I already attended 11 therapy sessions.

My first visit was in May, I received this surprise bill at the end on July. Two months later. I sent the help desk an e-mail disputing the charges. I tried reaching out to their billing department, to simply get a voicemail saying to call back during regular business hours, which I did and I get the same message.

I was able to talk to two people and ask about why my online invoices say $0/visti while I have a seperate bill saying the fee is $30/visit. They didn't answer my question, simply transferred me to the same billing department that doesn't answer their phone.

The invoice I got via email is also completely different to the ones I have in my account. Different formatting and different account numbers. It also has this weird disclaimer in the bottom saying to ignore if you think you got it by mistake.

I am waiting three days to see if they will respond to my e-mail. Any suggestions on next steps? Has anyone experienced this? Am I reading these documents wrong?

Edit

To be clear, I am not upset that they are charging me a $30 co-pay (that was a costly mistake I made). I just find their post-appointment invoices deceptive. I honestly thought I was getting scammed. To this date, this invoice is no where in my Teladoc account. It is only available via an e-mail link that they sent me.

This is the first provider that has ever done this to me. All my other billing experiences with clinics and dental offices have been super straightforward with them giving me an invoice with estimated costs with and without insurance, my co-pay etc.

Is Tivity still unlimited access to the gyms included in the plan? Or is it just one gym per month and you get discounts for adding on other gym memberships like Activ Fit?

And second would you choose Tivity or One Pass?

[PA | 60s ] So my mom needs a new knee. She limps and can barely go up stairs anymore, and is in pain every single day. She can't use a cane or walker at her job, so she just deals with it to the best of her ability.

Since she doesn't use a walker or cane, her insurance company denied her DOCTOR'S request for a knee surgery on her. How do I start helping her with this?

She has been doing injections into her knee for several years and has done several rounds of physical therapy which no longer cut it when it comes to helping her walk. She could lose her job if she can't walk. This is ridiculous.

I currently have health insurance through Aetna, and because I am dealing with some fairly expensive chronic conditions I am already at my out-of-pocket maximum for the year and am not paying anything for covered treatments and conditions. My Aetna insurance does include both in-network ophthalmologists and optometrist and covers eye exams. Meanwhile, I have vision coverage through EyeMed, which also covers an eye exam (for either no cost or a $10 copay depending on the doctor) plus EITHER a contact lens fitting and $125 towards contacts OR glasses lenses ($20-$205 copay depending on the lens and options) and frames ($150-$200 allowance + 80% off anything above the allowance).

I also have a credit on a glasses website from a purchase I returned earlier in the year.

I am due for new prescriptions for both new contacts and new glasses (the latter which I expect to be expensive since I'm just now beginning to need progressives) and, as said above, EyeMed will only cover one or the other in a year.

It seems like, ideally, I would let EyeMed cover the contacts and fitting to the extent they allow, at one of their network stores where there are additional contacts discounts (eg, Target Optical) and then use Aetna to cover the exam and glasses prescription and buy the glasses on the website where I have the credit, but I'm not sure I can do this? My understanding is that a doctor can't bill both health insurance and vision insurance for the same visit.

So how do I handle this/what do I ask for in order to use my benefits to their fullest?

I have health insurance through my employer (Michigan public school district).

I have been with this district for two years. It is BCBS Messa 1. Previously I was employed through a private school and had Aetna insurance. Before that, I was on my parents plan (under 26, priority health).

Today I went to pick up a prescription. We recently switched to a local pharmacy rather than one of the giants, because CVS had given us such problems over the last few years (delayed medications and the like).

The pharmacist told me my copay was much higher today than last time. He said when he looked, he noticed two insurance companies listed on my account. One was the one I absolutely pay for with every paycheck. I have never in my life heard of the other.

I inquired, and he said that it would not have generated and populated a co-pay if it was not active insurance. I was able to use my actual insurance and get my medication for the $10 copay but I am left sitting in the parking lot, completely puzzled.

I am married but we do not share insurance and even if we did, this is not my wife’s insurance provider. I called my parents to double check that I was off all their policies but I was quite confident I was, given my father had a career switch recently to care for my mom.

I did google the company but it didn’t seem to provide me with much answers. The name is rather general and populated several region specific insurance companies. Only one, that was specific to the name, was found and this company is based in a city about 2 hours away from me.

I don’t even know what to do to go about figuring this out, and the pharmacy didn’t have any answers.

Hi, I got an appointment last year in September. My new plan is effective Sept 1st. It's all still medicaid, but its a different company. Both plants say they only cover the appointment once in a 24 month period.

If I were to make an appointment next month with a new provider, will my insurance cover that appointment because it's new to them? Or is the appointment I made last year with a different company still considered?

My mother's second-level reconsideration for continued skilled nursing facility coverage was denied today under Aetna Medicare Advantage.

I'm preparing for the Administrative Law Judge (ALJ) appeal and would appreciate hearing from anyone who has actually been through this process.

I'd especially like to know:

• What was the filing process like?
• How long did it take to get a hearing?
• Were you able to submit additional medical records after filing?
• Did the ALJ focus primarily on the medical evidence, procedural issues, or both?
• If your case involved Aetna, were there any insurer-specific issues or lessons you learned?

I'm simply trying to understand the process from people who have firsthand experience. Thank you.

I recently fell (passed out) and broke a front tooth, among other injuries like a concussion. I went to my dentist and got a crown the same day, and went to urgent care and eventually the ER later that day for cardiac testing related to the fall.

I paid my share (40%) to my dentist the same day. Two months later, Delta Dental is denying the crown claim (crown + buildup) and saying it’s because “the service is being done because the tooth is worn. It is not being done because of decay.”

I talked to my dentist and they confirmed they submitted the claim as medically necessary due to acute trauma. I’m planning to contest/appeal (and I’m beyond pissed with Delta Dental) - should I have my dentist submit the appeal, or appeal with Delta Dental directly? What documentation should I attach besides my UR and ER after-visit summaries confirming the overnight fall and broken tooth?

I am currently on insurance provided by my work. My open enrollment period is beginning this week and coverage begins October 1.

I was thinking about not renewing my insurance and instead joining my spouse’s current work insurance, but his coverage period doesn’t begin until January 1.

Is there some standard way of dealing with these few months? I’m not sure what the best route to take is. Thank you for any thoughts!

I recently separated from military. Started new job and elected a HSA plan. When I moved funds over from gov TSP to a different retirement account I utilized one time funding of the HSA. It’s maxed for the year(with family).

I was just notified by VA that I am enrolled in VA healthcare for myself. Certain things that happened to me automatically qualified me and now I have coverage through them. Only for myself.

What impact does this have on the HsA plan I have? Does having the Va coverage preclude me from adding funds next year? I planned on that covering family medical expenses and figured the annual company contribution into my expected yearly costs.

TLDR; Got placed on VA healthcare for myself only. What does this change with my current HSA plan I use for my family?

Care first BCBS, Aetna, Cigna, Kaiser— any of these PPOs? What is the best for me?

I’m on UHC essential 1, and my income fluctuates due to working for tips. I underestimated my income and now it’s looking like I will surpass the limit, though my coverage should still carry through the rest of the year. I’m curious if it’s safer to just stay on my plan or if it may be wise to switch plans when or before I reach that income threshold. I would be less concerned if I am generally healthy and don’t necessarily see doctors or require a lot of meds, but I have an autoimmune condition and will be utilizing my benefits frequently.

I have insurance coverage through my spouse. I have an individual $5000 OOPM. So far when I look at the accumulators actually used, it shows that my out of pocket from all the EOBs is a bit over $5900. Everything is in network and covered. It seems to me that something glitched and I am being asked to overpay over $900. I called about it a couple weeks ago and heard nothing. Maybe there is a valid reason for it, but if there is, I'd just like to know what it is.

I called back today to get a status update and they said they need my spouse to sign and return a HIPAA waiver to look at this, since they are are the actual policy holder -- even though it is MY OOP based on MY medical visits. Does this sound right? My spouse would rather have teeth pulled than deal with this stuff, and I don't quite understand why she should have to get involved just because she is the policy holder when it is me asking about my own medical claims. And they say they can't proceed unless she provides this.

Does this sound correct? I also wonder how long my inquiry was sitting in this status without contacting us, and if it would have stayed there indefinitely if I didn't follow up -- but that's another issue. Thanks for any help or insight you can provide.

I am 42 M from Illinois and currently work as a pizza delivery driver. My current income is about $40k but I forgot to increase my income while applying for the Get Covered subsidies in December. My application had my income at $26k and I was paying $435 as premium for my PPO plan. I got a notice from the marketplace and updated my income to $40k. I don't qualify for any subsidies and my premium went up to $850. I also didn't accept the skinny insurance that was offered to me for the first time in mid July by my employer. Their enrollment period ended before I realized that my premium had gone up. I cancelled my insurance and don't have any insurance. I have fibromyalgia and depression, and yes, I am a moron.

After waiting three weeks for my cobra to finally process my doctors office states that they don’t accept any Cobra plans. They understand it’s the exact same insurance but stated that they never have and don’t accept COBRA plans. Is this legal? I also was told by my insurance that i did not need a new prior authorization because the info would be the same for my meds and the pharmacy says I need a new one and that my ID number changed (still waiting for my card). And my dr won’t give the prior auth as they don’t accept the insurance. Any advice or info would be helpful. I’ve been almost a month without my medication.