My wife and I recently lost our health insurance through our employer so I went on the Marketplace to checkout our options. The lowest plan we were offered is $550/month, doesn't include dental, and has a $20k deductible. Lol. What a joke USA.

I went on BCBS website to see what individual plan would cost and already seeing better options. I chose "Marketplace options" through the insurance website, so I guess it's still from the "marketplace", but these options weren't available directly on the marketplace website.

Does anyone ahve any insight - and have you purchased directly from the private insurance website as opposed the the government one?

I’m an international student starting at UMD this fall as a junior. UMD is charging me about $3,000 for the Student Health Insurance Plan (SHIP), but I saw that it’s possible to waive it if you have your own insurance that meets their requirements. They mention that the plan must be ACA-compliant.
As an out-of-state international student, tuition is already incredibly expensive, so I’m trying to reduce my costs wherever I can.
Has anyone here successfully waived SHIP? If so:
● What insurance did you use?
● How much did it cost?
● Was the waiver process straightforward?
I’d really appreciate any recommendations or advice. Thank you!

Hi! By my current calculations, I currently am eligible to enroll in the NYS Essential Plan.

I was curious as to what happens my calculations were not correct/if I end up making more money than the income limit by the end of the year after I am already enrolled and started utilizing the plan?

Is this a parks & rec “jail” scenario? Or am I going to be ok?

Thank you!

I’m an international student in New York. My university requires health insurance that covers routine care nationwide, not just emergencies or urgent care outside New York.

Does anyone know a plan that meets this requirement?

So I (newly 26) can no longer be on my parent’s tricare plan, and in recent months went through the application process for my state’s fssa benefits for the state healthcare plan. There’s a lot I could say for how confusing it all was, but putting it aside, I checked today and it said I was denied for lack of proof of residency and of previous insurance coverage.

I submitted my learner’s permit and it should’ve been fine as far as I know? For the previous insurance, that might make more sense- I submitted photos of my father’s military ID since that’s what we’ve always used as proof of insurance and medical places etc before since it has his numbers on there, and I don’t have any other actual documents about it or my own account, just a dependent offer through him.

So my options now are appeal (court???) or look for another insurance. In the past two years or so I’ve come down with an illness that has been treatment resistant so far (a severe ibs case, and possible endometriosis the docs think) and I can’t work right now until we find medication that helps, so that’s out. I also have a lot of doctor visits and medications because of that. Should I go to marketplace or appeal? Going to court is also an issue because of my illness and complete lack of knowledge on court shit. Please advise.

Reddit keeps suggesting I post this here. I hope it and the original post are helpful for the community.

All the best!

Hi I’m a US citizen who needs gap insurance before leaving the country in September. I don’t have an income. I just was to buy it out right.

Didn’t realize that my small employer (less than 20 employees) had contracted health insurance through a large PEO and accepted health insurance. The PEO coverage was through United Healthcare.

I was under the impression that my Humana Medicare advantage was still primary. I went to have a kidney stone removed at a facility that I now know to be out of network with UHC but in network with Humana.

Both insurances have denied the claim of about $2,300. Do I have any options or am I on the hook for this procedure?

My insurance (BCBS MA) denied a preauthorization request (actually 2 at this point). For the first, the provider’s office attempted to submit documentation that showed I met the criteria for coverage, and they received a response back that there are no pre-service provider appeals, and to check the denial letter for next steps. The denial letter states providers have 180 days from the date of the denial letter to submit an appeal. The service was then performed.

For the second denial, I did not find out that it was denied until after the service was performed (on the way home from surgery) - the denial letter was dated only 2 days before the procedure, and the provider’s office only posted it to my patient portal the morning of my surgery. I received the mailed copy from BCBS a day or two later. When I asked the provider’s office about submitting appeals with the documentation to show I met the criteria for coverage listed in the denial letters, I was told that if they submitted an appeal it would be automatically denied because it’s now after the service occurred…which, given that BCBS rejected the pre-service appeal on the basis that it couldn’t be done pre-service, makes absolutely no sense to me. How can a provider have the right to appeal within 180 days, yet they can’t appeal before the service or after it?

Is my provider’s office just giving me the run around? I have seen the letters BCBS sent to the provider stating they had 180 days to appeal, as well as the letter stating there are no pre-service appeals, but it sounds like an assumption regarding the post-service appeal of the preauthorization denial.

Can anyone shed some light on this situation? I have contacted BCBS for clarification, but was told another department would reach out to me about it, and I still have not heard back yet. I will reach out again, but stumbled across this sub as I tried to find info, and am hopeful there are some knowledgeable people that can offer some insight.

I understand I can submit an appeal, and I have done so for the first denial, as that window for appeals was coming to a close and I was not getting anywhere with the provider’s billing department. However, the second appeal is more complex, and requires a clinical explanation. My doctor offered to provide a letter for my insurance, but then suddenly retired, and I do not have this letter, nor the medical expertise to do it myself (at best, I could summarize it in layman’s terms, which I don’t think will be sufficient).

I am already being billed and my cc charged (including after I told them I don’t authorize any future charges unless expressly authorized charge by charge due to the outstanding insurance issue) for some of the services that were denied, despite the provider’s payment policy which requires payment in full before service if they do not have a preauthorization on file.

If anyone has made it this far, thank you for taking the time to read all of this. This has been an extremely stressful situation.

I received a letter in the mail and am confused by it. I tried searching and found on a Kaiser sub about it not being a scam. The reason the letter is confusing is it talks about me suing someone and providing my insurance company money from any settlement I get.

I’m not suing anyone. Yes I was in a car accident. The person didn’t have insurance so there’s nothing to do. I was thankfully not injured and only had an initial exam same day as accident. If I call the person on the letter and say I’m not suing anyone, there’s nothing to sue, that is all that’s potentially needed? I’m not winning any settlement (because I’m not suing anyone) and my car insurance didn’t pay for medical expenses, only car expenses.

I had a pre-authorized in-lab sleep study with a in-network provider in late May. Due to my insurance company (United Healthcare) having a miscommunication with my provider, my insurance company didn’t get the treatment records until mid-June. United Healthcare then referred the claim to the specialized review team after my provider submitted a reconsideration request. United Healthcare initially provided a 7-14 day estimate for when that extended review would be complete, but it is now past that time. They’re now saying they don’t have an idea of when it will be reviewed, but just depends on when the team gets to it. I also pre-paid my deductible for this test so that money has been stuck on hold until the claim is processed…

Is there a way to get my insurance to process the claim with more urgency?? It seems weird to me that it is taking this long for a pre-authorized claim to take this long to process.

Specifically if you are type 2 and it helped get your A1C down for a few years but you had a bad year and A1C went back up? Can’t take Metformin with it because I had too many bathroom emergencies.

Please help me choose. I’m in my early 30s. Which is better to choose? These are both from UMR provided my company, and I’m not sure which is better. From my paycheck, PPO is $140.60 and Surest is $128 per month.

My husband's company was recently sold to another company. They offered new insurance plans and had him select the plans. We waited for new insurance cards and mail to arrive and nothing. I have parental appointments, my kids have therapy and check ups so I continued with those appointments this month.

I asked my husband to ask HR regarding our insurance. They told him that the new company was still processing the changes and that we should cancel our appointments until wet get our new cards. Some employees had already gotten their insurance but not all. I had already gone to a few appointments so was upset. We were informed that the old insurance ended on 6/30/2026. We ended up getting a bill for my son's OT for close to $800 and cancelled our future appointments since they said insurance confirmed coverage ended. We are upset because we were left with no coverage for that time and I had already a prenatal and a check up for my other son. Those bills are probably coming any time soon.

I checked the mail today and the cards finally arrived. Can we ask the company to pay for our bills during the gap since it doesn't seem fair they did not do a great job of managing the transition and some employees did get their benefits before us? Or are we still responsible for those bills? What should we do?

I am 28 years old and have been morbidly obese since childhood. After moving out to college I started to build a healthier relationship with food and exercise but it has been hard. There have been many lapses, many regressions. I'm trying as hard as I can to lose weight on my own through diet (calorie restriction, Mediterranean diet) and exercise (mostly biking). I'm actually down about 30 pounds from the beginning of the year but I'm starting to plateau at about 315lbs. At this point my doctor and I both agree that additional help is needed.

Medically, I have non-alcoholic fatty liver disease which has progressed to Metabolic Dysfunction-Associated Steatohepatitis (MASH). I had a fibroscan at a facility in March which indicated severe scarring of the liver. In addition to this I also have high blood pressure caused by being morbidly obese. In mid June my doctor prescribed me Wegovy, which requires prior authorization with my insurance (United Healthcare). My plan unfortunately does not cover weight loss meds for the purposes of weight loss alone, but we were hoping that with the additional context of the MASH diagnosis and high blood pressure they would see that this is medically necessary to prevent further heart/liver damage.

I actually gave United Healthcare a call yesterday to ask about the status since it's been a month and I haven't heard anything and the advocate told me it was approved! Yippee! Except actually, when I checked the myUHC app later that evening it said denied. This led to an hour long phone call with them where they spent most of it with me on hold, waiting for them to tell me what I already knew, it's denied because it's a plan exclusion. I took the night to cool off then earlier this morning I called United Healthcare again to discuss this with an advocate and they told me what OptumRx (their Rx approval team?) was looking for. They want to see my fibrosis stage and my liver stiffness measurement, both of which were already in the original prior authorization. Did they just straight up not read the original prior authorization and stamp it as denied? I understand it's a plan exclusion but I should not have to appeal this to get this health insurance company to do their job correctly. Like, are they just hoping I won't appeal? What is going on here? Has anyone else experienced this? How can they deny me and then ask for additional details they have already been given?

This is Delta Dental. The Product is Delta Dental PPO (Standard)

The dentist is in the Premier Dentist network.

Can someone please help me understand this because the math isn't mathing.

07/14/2026 D0220

Procedure Name: Intraoral - Periapical first radiographic image

Submitted Amount: $38.00

Approved Amount: $26.00

Allowed Amount: $21.00

Deductible: $0.00

Office Visit Fee: $0.00

Co-Pay: 90%

Patient Pay: $7.10

Plan Pay: $18.90

07/14/2026 D0140

Procedure Name: Limited Oral Evaluation - Problem focused

Submitted Amount: $104.00

Approved Amount: $69.00

Allowed Amount: $60.00

Deductible: $0.00

Office Visit Fee: $0.00

Co-Pay: 90%

Patient Pay: $15.00

Plan Pay: $54.00

My family and I recently got new insurance and with it got vision insurance. We got it started on February 1st. My vision is extremely bad and only now am I needed a new prescription after a couple years, so tried to make an appointment but the office said that while they accept my insurance, they can’t find a vision card in my name, as in staring at the card in my hand. I sent them info and a picture and they still weren’t able to take it. So I checked my plan on the website and it says it was only active from 02/01 to 05/01. Why did I only have it active for 3 months? I understand that there is a limit of 1 exam per year which makes sense, but 2 months ago I could see fine and now my vision is slowly but surely getting worse even with my glasses. I don’t get it. I’m new to all this adulting shit, so please help me out 😔