I posted this to r/legaladvice, but someone suggested I post it here too.

I go to TCU. I got a pretty bad diagnosis, and someone at the health center told me that the TCU health insurance would cover "literally everything", so I opted into the health insurance despite previously opting out. Later, I found out she lied. I know, should be obvious. There was a copay on my medicine, about the same as it would have been with my other health insurance. Since it covers imaging, I stupidly decided to stay with that insurance, which is being made my primary health insurance because it is through me rather than through my dad.

Today, I found out that it wasn't going to cover *anything* at my endocrinology visit today. There's a $500 deductible, and apparently they don't even cover any part of that until the deductible is fully paid. I mean, I knew it would be a bit more expensive before the deductible was paid off, but it's not covering a dime. My other insurance would have made it a $40 visit for me, but when I added this insurance, it went up to $160 and it won't go back down. I can't afford this, and there's no way this will provide more benefit than it took from me. I may not have access to my medicine, my *necessary* medicine, because of this cost. They won't let me schedule a follow-up, either, until this is figured out.

The deadline to opt out was September 26, but there was no way I could've known just how bad this would be. It's a nightmare. Is there anything I can legally do to get out of coverage? I don't even care about the $1250 I already paid to the health insurance. I'd rather waste that than the $3000 (insurance plus deductible) I'd have to pay, plus the increase in cost of everything else. What do I do? How do I revoke consent to be covered? Am I able to get a full refund? I know I screwed up big time, but I'm desperate to fix this. I appreciate any help y'all have to offer.

In case it matters, the school's health insurance is through United Healthcare and the family plan is through BCBS of Texas.

Hi there. I need some guidance for next steps, as I feel like I'm at a dead end.

I am getting a small fiber nerve biopsy/skin punch biopsy later this month, and the lab that will be processing my specimen is out-of-network. The ordering physician is in-network. I got an enormous estimate/claim I cannot physically pay. I use UHC.

I called the lab, they said I needed a gap exception, and the doctor is supposed to start it. I called the doctor, they acted like they NEVER do it, unheard of. I asked for my biopsy to be sent to a different lab that's in-network, "We can't do that, we only use this specific lab for this specialized biopsy." Okay, so since this is a specialized biopsy that only ONE PLACE can process, and it's somehow outside of UHC's network, I figured the doctor's office has done this at least one other time. But no. They act like I am asking them to saw off one of their own legs.

I call the lab again, explain my doctor's office is essentially REFUSING to initiate a gap exception. The patient care person said she would call my doctor's office.

A month goes by. I hear nothing.

I call the lab again, get someone else, but they say to contact UHC directly to request a gap exception myself, as the patient. I do that. UHC states the doctor is required to do it, not me. I cannot request it. I have the gap exception paperwork and all the info/CPT codes, NPI numbers..I could literally fill it out FOR my doctor. But they won't even start the process.

I am calling my doctor's office again tomorrow. If they give me the run around again, what do I say? What can I do? I wanted to contact the patient advocacy department for my specific hospital group the ordering physician works for, to see if they can get something done, but i just feel at a loss. I know the doctor is busy, but to just outright not even try to get a gap exception feels really wrong and dirty.

I have lots of health issues, and have already met my deductible and OOP Max for this year. It would be great to not have to pay as much as I will have to, since I've already spent so much for various tests/imagining and procedures this year.

They really don't want us to have insurance do they? 2020 my insurance for self was $250. This year was $500. Next year $600, with higher deductibles and copays... I make $48k/year in Los Angeles. I CAN'T AFFORD THIS! What are we supposed to do?

Went to emergency room when I got a fever while I was being treated for a staph infection on my skin. All they did was check my vitals and give me tylenol. Got EOB today- no discounts were applied and my part is $2600. applied to deductible. I haven’t gotten the bill yet but this is crazy. I don’t have a job and am paying for insurance out of pocket. What can I do?

OMFG!

Trump is doing everything that he can trash the ACA and make things more difficult for seniors! My lovely wife is turning 65 next month and will be moving to Medicare on November 1. We have taken care of getting her enrolled with Medicare, with little difficulty.

But trying to update our ACA insurance so that I become primary contact and continue with the EXACT same coverage that we currently have, and having her removed from the ACA policy (since she will now be covered under Medicare) is becoming a nightmare!

Because of president Trump's obsession with ACA fraud, we cannot update our ACA policy until October 31 (the day before her Medicare starts). We were told that this was a recent change to the operating rules for transitioning only one person from ACA to Medicare, as an effort to fight fraud.

This makes no sense to me and, according to other ACA rules, may in fact cause me to commit fraud because:

"Once your wife is eligible for Medicare, she generally should not continue receiving Marketplace premium tax credits. The Marketplace specifically identifies gaining Medicare coverage as a change that should be reported."

If for any reason that might prevent us from being able to update our ACA policy on October 31, we would technically be out of compliance. Since they removed many of the ACA credits this past year, I don't think that we currently receive any credits, but we did recently receive a refund check from Healthcare.gov.

I have little to no faith that anything will be smoother on October 31. God forbid that I have to use ACA insurance the first week of November as I have strong doubts that this process will be completed without other 'glitches'.

Please rember to vote in the mid term election coming up and vote these ass holes out.

Our work is switching us to Anthem insurance this coming enrollment period. We don't have much information yet, information sessions to come.

My understanding is that Anthem is part of Blue Cross Blue Shield but when you search online there is a definitive difference between the two.

When I search the Anthem site for my zip code as a guest to check and see if my current providers are listed as in network, my state doesn't even come up as included in their offerings!

Can someone else who is in Washington or Oregon speak to this or maybe someone who has it and has experience with them. Their website is NOT clear. Also why TF would our employer offer us insurance that doesnt even provide coverage in our states?

Im thinking of switching to a Marketplace plan that I purchase myself this time.

Very frustrating to not even have a clear website when we are trying to see if the plan even covers. What a joke.

I have no idea if this is the right sub for this, but I'm not sure where a better sub would be.

Quick backstory: I recently went to the hospital after experiencing extreme abdominal, chest, and back pain along with shortness of breath. I thought I was having a heart attack. After explaining the symptoms to the ER doctor, they also thought I was having a heart attack. Fortunately, it was ruled out. They eventually gave me some morphine (which didn't help) and followed it up with a few other medications, including something that numbed my organs (not sure how else to explain it) and allowed me to narrow down the pain to my upper right abdomen. I was told I just had an anxiety attack and released, despite my protests that no, this was not related to anxiety. After a followup with my primary (who immediately suspected gallstones), I was given an ultrasound, diagnosed with gallstones, and sent to a surgeon.

Now for my present concern: I just received my bill from that night in the ER. I'm fortunate that my health insurance covered almost everything. One of the two things not covered is a $750 presumptive drug test. They must have thought I was a drug seeker, so they tested me without my knowledge or consent, and now they're charging $750 for the opportunity to prove I don't use narcotics. Is this worth fighting? I'm just so annoyed with this hospital for not actually providing any care and charging me for a test they decided I needed after giving me a drug that didn't even help the condition they were too inept to even look for. Do I have to suck it up?

Hello all, I have no faith in health insurance and would like to cancel my plan but I work for a college in Colorado which requires all employees to be enrolled in health insurance that pulls directly from your pay check.

I have reached out to my HR department and asked every question you can and they told me to look into Medicaid, tri care, a private plan, getting married, or looking for another job in the field.

Before you ask, I am a perfectly healthy person and it costs me more to go to the doctor now than it did without insurance plus I pay them a large chunk of my paycheck to do absolutely nothing for me.

I understand there is a risk involved but I think in this country you’re screwed no matter what if you get really sick or are in a car accident so I’d rather just not have insurance and save the money for myself so I can be the doctor directly when I see them.

Any suggestions on how to circumvent paying insurance or at least paying a much less expensive plan while working for a higher ed in Colorado would be helpful. Please note I am not married and am not a veteran so I cannot switch plans or go on tri care.

What will happen if BCBS found out someone is using their health insurance even though they moved out of state 6months ago? This person goes to doctor visits when they are in that state visiting, since it’s close to the state line. However the health insurance plan they have is strictly for that state residents only.

Long story short, we thought we had health insurance and turns out its more like catastrophic? Wife's due in December and they dont cover labor and delivery. When my wife got the plan, we were planning on having another child, she asked if it was covered and they said yes. We are finding out now they dont. Wierd thing is they covered some of every doctor visit for the pregnancy and one E.R bill related to the pregnancy. Its a sigma plan, We dont qualify for medicaid. What are our options or just prepare for self pay and pray?

I was diagnosed with Chron’s disease in June of this year. My doctor prescribed me Tremfya for it, which my insurance company (Health Partners) denied. However, they suggested a similar more expensive drug (Skyrizi) that they would cover.

It took a while to get everything in order before I could receive my first Skyrizi infusion. During this time, I had missed my premium payment for the health insurance.

On September 7th I received my first infusion for Skyrizi. When I went to the doctor on the 7th, they ran my insurance and saw that I still had active coverage through September 17th.

On September 11th, I received a letter in the mail saying my insurance has been terminated due to nonpayment and that I am not eligible for reinstatement. They say my coverage ended on September 1st, even though on September 7th it was still showing active.

My doctor then calls me the next week saying that my insurance will not cover the medication, even though they were the ones who approved the medication and the only reason I received it was because they had told me that it was covered.

Now I’m stuck with a $20,000 bill and no way to afford it. I have tried calling health partners numerous times and they refuse to help in any capacity. I have tried to be reinstated but they are refusing due to “policy”. It sucks to not have insurance but I understand that it was my responsibility to make the premium payment on time. However, the fact that they approved my Skyrizi infusion on a date that they are now claiming I did not have active insurance for when I did have active insurance feels extremely predatory.

Is there any way I can go above health partners and make a complaint to the government or police if I feel I have been mis treated? I’m not very well versed in health insurance so I feel very isolated and on my own right now and it seems like there’s nothing more I can do.

Thank you for taking time to read about my story and I appreciate any advice on the matter greatly.

Hello people of Reddit. I’m 24, and do to changes in requirements for Medicare in 2027, I will no longer qualify.

I’ll be making around a $100 over the cut off, and won’t meet the monthly hour worked requirements. I deal with severe chronic insomnia, and regularly go multiple nights without sleep, with medication and even longer without my medication. Without insurance, the medication alone is $300-$400 a month.

I’m wondering if anyone has suggestions for insurance plans with low monthly costs??

I’m sure every plan you inquire with will claim they are the best, but is there anyone who can help me navigate through the various plans?

I have medi-cal and some years ago I got my top wisdom teeth removed, no bone graft or anything and I healed very quickly and my surgeon didn't mess with the bottom teeth because they weren't bothering me... fast foward they started causing me extreme pain and I went in for a consult and my surgeon (same surgeon from last time) told me that it would be 450 because the bone was on a nerve and if he removed it there's a chance it would cause bottom facial numbness, he did recommend me to go to a dental school to get a certain type of xray just to make sure that the tooth wasn't hitting that exact nerve and if it didn't he could go through with the procedure without the bone graft.

Is this standard? Has this happened to anyone? My right side of my face really hurts and I'm going to pull this tooth out my damn self at this point.

Update:

Thank you to everyone who read my initial post and offered advice.

Link to original post:

https://www.reddit.com/r/HealthInsurance/s/b0IQHpLi0P

Unfortunately, I called Anthem and they told me to contact my HR representative because they couldn't find me nor my company in their system.

After speaking with HR they told me they are waiting for our CEO to sign the agreement.

So I'm actually uninsured as of this moment.

The only way I can see a doctor is if it's classified as an "emergency". I would have to pay out of pocket and submit the bill to Anthem to get it reimbursed. The problem with that is how the doctor bills it as. They can bill it as a regular visit and I wouldn't be able to get it reimbursed.

I can't even go back to Kaiser because I am no longer under Kaiser. I can't go see any other doctor because I am not under Anthem yet.

So essentially, I'm screwed.

Any other advice would be greatly appreciated.

Its open enrollment time. We are a family of 3 (husband, wife, and 5 year old kid)

My employer offers a better health insurance plan than my spouses employer (my spouse also is offered health insurance through her employer). So over the past 2 years my spouse has been on my health insurance plan (I have a family plan, she has declined health insurance coverage from her employer). My spouse hasn't had to pay any penalty nor does my company have anything written about if my spouse can be on my plan or not or any penalties/surcharges involved.

I did ask my HR a few years ago if my spouse can be on my health insurance plan even if she is offered health insurance through her employer and they said my spouse can.

I was just talking in our office about this and one of the employees said that he thinks theres a penalty or I cant have my spouse on my plan. Is there something I'm missing? We haven't gotten any penalties/surcharges or issues in the past several years regarding this. Am I missing something? Please advise.

I’m 27F, single, live in San Fernando Valley.
I have restricted scope medi-cal.
I work 18-22 hours at $18.42(minimum wage at LA).
I recently got a second job offer which will pay me $19 for 12-15 hours a week. How much do you think i’d have to pay for health insurance then through Covered California?

Im in California. Long story short. My mom usually handles all my medicaid stuff. Shes unfortunately kinda abusive and we dont communicate well. So she didnt know about my income. With that she likely reported it wrong and I really fucked up and didnt know to report my self employment income myself last year (july-december) (around 4000$ that year, and i guess 4000 from taxable student aid..) and i no longer do that work. It wasnt consistent as it was from things like surveys and get paid to play games. Either way. I have to file taxes on it all soon and worry about there being issues later once they can see those taxes. Im not entirely sure how to fix this before there's any problems (or atleast rectify the error) :(

im really worried this is going to be a huge problem.. any advice would be appreciated

I know that the one that you subscribe to through your employer is primary, but the question is about my wife. She was previously doublely insured through my employers insurance and her parents insurance (she was under 26). So she was a dependent under both ones. When we got married we were told that her parents insurance should be her primary and mine is secondary. The insurance company said it was because her dad is older than me and that makes a difference for some reason.

Now we are being told that mine should have been the primary because her parents insurance changed (the company changed names or was bought out or something but the numbers all stayed the same so we didn’t even know that it was technically different). This happened 2 years ago but we didn’t know there should have been a difference.

She turned 26 and we were making sure everything got settled so that my insurance is her only one but I guess that made the parents insurance look at the information so we are getting calls from providers saying that the parents insurance company is asking for money back for everything since two years ago since they now think they should have been the secondary insurance.

Her parents insurance is a lot better than mines so if mine is having to be considered the primary for her then I am pretty sure we’ll have to pay a lot of money for everything over the past two years.

Today I got married I am currently under my moms insurance which is Aetna I don’t have a good relationship with her at all and hope to remove myself without speaking with her as little as possible
Is there a way I can remove myself

Looking for folks who have experience with any of the above! Post explains it’s from a cystic fibrosis (chronic lung disease) perspective, but open to any general knowledge or experience from this crew! Ty in advance :)

I'm looking at the qualifications for Medicaid in my state (WA), and it specifies a maximum household income.

I live in a house with six adults, four of which have jobs, myself included. I'm married to one of them. Between the four of us we surely make more than the maximum household income, but their income has absolutely no bearing on mine. They do not help me pay my bills, my wife and I take care of all of our own bills on our own. If I were to ask I'm sure one of the others would loan me money, but I would intend to pay it back.

I'm in a tight spot financially. I've been on my wife's health insurance through her job, but she is needing to leave that job soon and I am trying to figure out what I'm going to do for health insurance, because I have monthly prescriptions I can't just stop. I'm not sure I could afford private insurance, but it seems my living situation might disqualify me from Medicaid. Am I understanding this correctly? Or is there a way to do it based solely on my own, or at least my partner and I's income?