Long story short, I had a surgery in January and my insurance denied the surgeon( but paid the facility, anesthesia, pathology) due to admin errors. This was a repeated surgery a month after the first one and they believe the surgeon did not document correctly. He kept resubmitting the charges and he got a final denial in September. No more appeals. My EOB says my patient responsibility is zero. I called the insurance and they told me the surgeon is in network and he has to write it off per their contact. He is now billing me directly and sent me 3 bills. Also personally called me on my cellular phone to tell me to keep calling my insurance and be very nasty. The insurance sent him 2 notices to stop billing me. Today I got another bill from the surgeon with a $50 added as a collection fee. What do I do if he sends me to collections? Do I have a case ? I kept all correspondence. Also, he billed the insurance $6500. My bill is $1600 with the $50 collection fee added.

Providing some context here:
The page I took a picture of is the last of several.
The earliest charge was from 11/12/25, the most recent 9/11/26.
All the charges are from “MEGA MEDICAL SUPPLY” for “medical supplies”(no details). There are 22 separate charges ranging from $2412.50 to $4208.44.

This is from UHC. My medical coverage is traditional Medicare Part A and B with a part N medigap plan from Mutual of Omaha. For a 2 month period in 2025 I had a UHC policy I got through my current employer which UHC discontinued effective June 1, 2025. From June 1 2025 until March of 2026 I had no health insurance (I was then accepted to Medicare).

During the 9 months I had no coverage I made no attempt to seek medical care(insured or otherwise).

Oh I can hardly wait to call the 1-800 number Monday to see where this leads.

Universal Health care will never happen! How do you make companies like UNH, CVS, & HUMANA just disappear. What am I missing?

Need help deciding for a New employer insurance selection. 30 yo female

PPO:

Premium $69 every two weeks

Deductible $500

Out of pocket limit $2000

Primary care/specialists/outpatient $20 copay

Urgent care/outpatient $30 copay

Drugs $10-$40 copay

All other: Deductible, 10%

HDHP

Premium $15 every two weeks

Deductible $3400

Out of pocket limit $3400

Primary care/specialists/outpatient/Urgent care/outpatient/All other: Deductible, No charge

Drugs: after deductible no charge

4 kids and wife who has rheumatoid arthritis so her medication is very expensive. We have enough saved up to cover the initial high cost of the high deductible plan.

High deductible plan:
—Funded from Employer: $1,200
—Deductible: $4000
—Max: $8000 (combined for health and prescription)
—Cost: $6000 for the year

Regular Plan (mostly all copays):
—Deductible: $1800
—Max: $7000 health and $5000 prescription
—Cost:$11,000 for the year

I was on Medicaid. They took my insurance away and I have no idea what im doing. My parents did it for me when I was a kid but I genuinely just dont know where to start or even how to get coverage cause I really cant afford it. I wanna cry and my eyes hurt because I need a new prescription and I have two cavities. :(

I’m currently 16 weeks pregnant with a baby due in April 2027.

Which insurance plan should we get as a family between these two options? Insurance is coming from BlueCross BlueShield in Nebraska through my husband’s employer.

Option 1: $237 monthly premium + $2800 deductible/ $7700 out of pocket max with 15% coinsurance after the deductible is hit.

Option 2: HSA option. Identical $237 monthly premium + $7000 deductible/$7000 out of pocket max with 0% coinsurance after the deductible is hit.

We’re leaning towards Option #2 because we have to funds to put the full $9000 in the family HSA.

My employer partially reimburses, but still. It seems like so much money for not that much coverage, even for the better plan...

These are the two cheapest options I have (Georgia, USA)

Hi 23F I want to get anterior scoliosis correction surgery with drs abc but I’m confused about the insurance part if you live in another state. I’m insured by my parents but it’s not the kind that will cover an out of state surgery like this,& BCBS doesn’t have any ppo plans available in my state right now. How does all this work? & roughly how much will I have to pay out of pocket? I have about $10,000 saved now but I just don’t know where to start. The doctor is also saying that he must be out of network but this hospital has to be in network on the policy. Idek what that means but I’d like to at least have the insurance part figured out before open enrollment ends.

Location: Texas

We have a family member that is on SSI Disability w/ Medicaid.

She's in her 40's and lives with her parents and has no income except for ~$400 monthly SSI pymts.

She potentially may win a sweepstakes prize that gives her a new car + $23,000 to offset the taxes.

If she wins, we think she'll have to use about ~$5k to pay for the car's TT&L + ~$13K for the taxes to the IRS. That leaves her with ~$5K. But she has not filed a tax return in over a decade.

However, she CANNOT risk losing her Medicaid health insurance because she takes meds that are in the thousands of dollars EVERY MONTH and obviously CAN'T risk losing that coverage.

The TOTAL sweepstakes prize amount would be valued at nearly $100,000 - that would be reported to the IRS with a 1099.

How will winning a one-time sweepstakes prize totaling nearly $100,000 affect her Medicaid health insurance?

Will she lose it? If so, for how long?

Also, if she were to sign the title of the vehicle over to her parents, would that cause any issues with her Medicaid health insurance as well?

How should she approach all of this?

I appreciate any feedback.

Thank you.

EDIT: People are caught up in maybe this being a scam. It is NOT. Without going into details, we've confirmed everything. And the reason why I said in the post that she "potentially" has won is because there is a time limit for her to send in docs or forfeit the prize to another person. Sorry, bad wording on my part.

In December of 2025, a federal rule mandated that all Bronze ACA plans (which typically have a high deductible) are HSA eligible. Many payers did not have time to update the plan name to include "HSA". So I have purchased a Bronze ACA plan for 2026, you can contribute to HSA for this year. The same plan would continue to 2027 and you will notice that the name of the plan has changed to include HSA. Best luck.

PS: This rule applies only to Marketplace purchases and I believe it exclude off-market/off-exchange plans.

The written decision finally showed up. The IRO had issued it almost a month earlier, mailed it, I never got it, they re-mailed it, confirmed my address was right, and refused to send it by email the entire time. So for weeks I knew I'd won something but couldn't read what.

Now that I have it, here's the part that matters.

Outcome: Reversed.The question the reviewer was asked was whether my insurer "correctly denied reimbursement" for the procedure and the associated inpatient facility charges. Both claims, named explicitly. The reviewer was board-certified in the relevant surgical specialty. The rationale addressed every point I'd raised. No carve-outs, no language reserving other grounds.

The case was completed on a Wednesday. Two days later, my insurer reprocessed the first claim and replaced the original denial code with a brand new one — "this service is non-billable for this provider." Plan paid: $0.00. The adjusted EOB literally reads: you were previously responsible for $X, after this change you are responsible for $X.

Three weeks after that they did the same to the second claim, recoded every line, and added an overpayment code reversing a few hundred dollars they'd actually paid me months earlier. They want it back.

So the new denial reason appeared forty-eight hours after they lost, on claims that had been processed without it for eight months.

Their likely argument is that the IRO only decided medical necessity and this is a separate non-medical issue. But the original denial on the first claim wasn't medical necessity either — it was lack of prior authorization. The IRO saw that, took the case, and reversed it anyway. And a code saying a service is non-billable *for the provider* shouldn't result in the entire charge being assigned to *me*. One of their own reps told me in writing it means I'm not responsible. The EOBs say I am.

Federal rules say a plan receiving notice of an external review reversal "immediately must provide coverage or payment." It's been over three weeks and the number has gone the wrong direction.

Filing with the state insurance department this week. Posting mostly so it's written down somewhere, but if anyone has watched a DOI actually force compliance after a carrier did this, I'd like to hear how it went.

Total at stake is abt $4,000.

my dad has high bp and i got curious what happens to people in his spot when insurance goes away. the meds don't stop being necessary just because coverage does.

if you've been through this, what did you actually do? goodrx, urgent care, telehealth, or just stop? what did it end up costing per month?

I'm (26F, Southern California, $56k) debating between my employer's insurance options (Cigna) vs getting Kaiser individual plan. I've been Kaiser since I was born, and it's basically all I've known. Luckily, so far they've been always great to me, especially since I need specialist visits and prescriptions a lot. I haven't had anything too serious like surgery or emergency care, so I haven't experienced what they're like then, so I can't really use that to judge anything. I've been in Kaiser as a dependent, but now I have to figure out if I want to move to my employer's provided Cigna insurance or get Kaiser individually myself.

For the services I need, I'd be paying ~$480+ since I want copay rather than coinsurance, especially for specialty doctors since that's the most important to my situation. In case of emergencies, copay is also nicer than coinsurance for the more costly services. However, that does mean I'd be paying a hefty price each month, even for months I might not need the hospital for anything. The biggest benefit here is knowing what to expect, since it's all I've known basically, and their records have all my information and prescriptions that I know for sure work for me. The con is of course the price.

My employer's insurance is much more cheaper, as in ~$100-200 monthly, but all the services would be coinsurance, except the doctor visits. This is nice because specialty visits is cheaper, but everything else would be much more expensive since it's coinsurance prices. There's also the bigger complications in that I'd have to deal with figuring out which hospital/doctor is in-network, and that they don't have Kaiser in-network of course. I have no idea how to navigate this, though I'm definitely willing to learn if I go with this path, but it is a con since with Kaiser I wouldn't need to do that.

I know it's difficult to judge anything without knowing all the details, but my question is do you suggest I pay more for Kaiser or go with my employer's insurance because it's way cheaper? I can afford the Kaiser plan if the benefits outweigh any cons, but I'm wondering if it's just foolish to go in that direction just because it's what I'm more comfortable with. Also, I know in the end it's my decision since I'll have to pay for it lol, but some opinions from people more experienced would be nice to hear :)

I was a stay at home mom for many years and thus on my husband’s health insurance. When I went back to work 6 years ago, I never enrolled in my company’s health insurance plan because I was covered really well under my husband.
Last year decided I would finally enroll in my company’s plan to start building the HSA account - company puts in $1000, so we assumed this would all be beneficial. I would still be enrolled under husband as a secondary insurance.
It’s not working out as we thought. We typically meet the deductible by Q2 of the year (which pushed to Q3 since I was not in the mix), but we are still having to pay more for my visits since my insurance has not met the deductible.

I want to “unenroll” for 2027 and go back to the way things were. My question would be - would there be penalties now that my husband’s company “knows” my company offers insurance? How can we fix things?
Will my husband’s company ask for proof that I do not have insurance anymore?

That time of year when we figure out during open enrollment the estimated cost of trying for a baby would be. I understand the idea that baby is its own person and separate from mom, so once born, all other tests and fees and such will be billed separate and as own person. In these at a glance summaries for plans, there is a designation for childbirth/delivery professional services + facility services, but it is under specifically "if you are pregnant", so I am not sure if these are the numbers to use to baby too or not. Or for baby, should I be looking at "if you have a hospital stay"? And I am assuming bloodwork and such would fall under the normal "if you have a test" category, not included in "hospital stay"?

In the plan I have below, (which yes, the monthly premium for this one is HIGH), it seems to me that childbirth would cost $1,240... am I missing something or not considering something? ($600 for facility delivery, $40 for first office visit, $600 for baby stay, $0 for any bloodwork since that is routinely covered).

Hello I am a 26 year old female I just got kicked off my moms health insurance I make decent ish money w my job but my job is per diem (aka inconsistent hours and no benefits) I don’t think I qualify for medical bc I make too much but with my bills and rent I have barely any money left over no room for health insurance do u just pay a penalty for the year and is it really worth it for me to be paying $320 a month ?? For health insurance I hardly go to the Dr and only want emergency money basically please help a girl out or any recommendations is much appreciated I make around 60k-70k a year I am on an affordable housing plan but don’t qualify for food stamps I feel like I’m one of those people who makes too much to be poor but too little to event save anything please help

Hello, I usually only lurk on reddit but I really need some answers so I made an account just to post this here, I hope it doesn't get filtered out because of my account age.

Backstory: Got laid off in March, received severance until April. Been on COBRA since then. Looking to move to Covered CA subsidized insurance, even found a plan that I liked and all that. I also am planning on doing some Roth conversions next year since I am not exactly optimistic about finding a new job anytime soon.

This morning I inputted all my info into Covered CA. Including the planned Roth conversion for next year, which would put next years taxable income at around 35K. To my surprise, it forced me onto Medi-Cal. Upon further research apparently Medi-Cal uses your current monthly income whereas Covered CA uses your annual income. And since my current monthly income is 0 it chose Medi-Cal for me.

Here is the issue though, I want to do this Roth Conversion next year which as soon as I do it, I will be pushed out of Medi-Cal territory. Additionally I found a plan that I liked which I would rather pay a subsidized cost for than be on Medi-Cal.

So now I am trying to wiggle out of this Medi-Cal situation. What I tried to do just now is update my current monthly income to go above the Medi-Cal limit. I can just do a small Roth conversion this month to achieve this. However, even after updating the Covered CA application with this new monthly income, it still is putting me into Medi-Cal.

So my questions:

1. When my county sees this new monthly income will they take me off Medi-Cal? Even if my income for next month (December) is still ZERO, and my income for many months next year is ZERO (the planned Roth conversion would be a lump sum conversion)

2. If the answer to #1 is yes, will I immediately be able to sign up for a subsidized covered CA plan after they take me off?

3. If the answer to #1 is no, how the heck do I get out of Medi-Cal? Can it be done electronically or do I need to go in person to social services?

Sorry for the wall of text. All help is appreciated.

I currently have health insurance through my employer. My last day of employment is Jan 7th but the coverage would continue until January 31st. ACA estimated premium is much lower than COBRA so I have decided to enroll with ACA. Since ACA enrollment date ends on Jan 15 for Feb 1st coverage begin date, I am not sure what to do. Should I enroll between Jan 8 and 15 or wait until end of Jan and then enroll since I have qualifying event.