r/HealthInsurance

I've had pretty good experiences so far in the 9 or so years I've had Highmark Blue Cross Blue Shield insurance, but I'm just in absolute shock right now....

My wife and I have a 16 year old who has been through a lot of mental health struggles in the past few years. Substance abuse, self-harm, online trafficking, you name it, this kid has somehow experienced it.

We're on our 3rd residential treatment stay now for them and this place (All the way in california, we live in Illinois) was really looking like it might finally be the answer to all of our troubles. They've been there almost 60 days now and just yesterday morning their therapist there mentioned that their case is so severe that they may end up in residential (or something similar) until they're 18.

Then about 2 hours later we got a call saying that insurance had stopped approving their stay and they'd be discharged on Saturday.

My wife and I are gutted. We don't have their bedroom cleaned and re-painted yet, we were going to replace the flooring in there, organize everything for a fresh start.

My wife actually had planned to fly out there and visit our child this weekend becuase they'd been feeling lonely and she wanted to give them some motivation to keep working the program and finish it out... So she's on her way to California now, which we canNOT afford, and I'm at home looking down the barrel of having to clean and paint their bedroom tomorrow, gather up anything dangerous in the house and find somewhere to stash it (becuase they destroyed our safe just days before we ended up admitting them)

the doctors at the facility were all completely shocked at Highmark's decision to deny , and then subsequent decision to deny AGAIN after having a higher-level meeting about it.

I don't feel safe with this kid in my home. I don't know if I can KEEP them safe from themself. This is complete negligence pulling approval with only 2 days to prepare our home and a safety plan.

I don't know what to do

So I got my own health insurance on marketplace this January without telling my parents (they've threatened to revoke it before so I covered my bases; transphobia, homophobia, and some abusive stuff) and I remember putting something about them not claiming me as a dependent because I figured im 20 and pay most of my own expenses (food, tuition, rent, gas, now health insurance, they only pay car insurance plus whatever their job insurance thing is) but I think they may have put me as a dependent from how they talked about filing their taxes.

Should I be concerned about this and could it affect my coverage? Do I need to fix anything with my application for tax credits (its covered my insurance entirely based on my income, exlcuding dental) so there arent any concerning consequences, if there are any for their own actions? Can I make sure they dont know i have my own insurance for as long as possible? (Planning on telling them to remove me from their job provided insurance in november since thats about when their enrollment period is). Any advice appreciated ❤️

I’m dealing with a super frustrating insurance situation and could really use advice or to hear if anyone’s gone through something similar.

Back on 12/1/2025, I had bloodwork done that was ordered by an endocrinologist I was seeing for the first time. I went through Quest Diagnostics, and both the doctor and lab are in-network with my insurance.

About two months later, I got an EOB from my insurance that actually listed my responsibility as $0 because they were still waiting on additional information from my doctor (medical necessity letter, records, diagnosis, etc).

But despite that, Quest still billed me $3,200.

I had no idea that some of the tests ordered might not covered. No one flagged that to me nor was I aware. I’ve truly never had to pay more than $100 max out of pocket for bloodwork of any kind.

Some of the codes are listed as “Medical Services” and also the more expensive charges I have on the EOB (one of them is roughly $2000).

I tried appealing with my insurance, but it was immediately denied because they still never received the requested documentation from my doctor’s office.

Now I’m stuck in this loop where:

- Insurance says they need info from my doctor

- Quest says they’ve also tried reaching out and haven’t heard back

- I can’t get ahold of the doctor’s office at all or when I do, they tell me they never got a request and tell me to call my insurance

I’ve called all three multiple times and just keep getting bounced around with no real progress. It feels like I’m getting stuck in the middle of an endless runaround that’s completely out of my control.

Has anyone dealt with something like this before? Is there anything else I can do here or any way to push this forward so I’m not stuck paying the entire bill?

Any advice would be really appreciated.

is anyone else paying almost $1600/ month for family coverage for BCBS PPO? with a $14800 out of pocket maximum? or is it just me? This is Illinois too.

I have a delta dental policy. once I log into their portal I was able to find and download the summary of benefits and certificate of coverage documents. but both of these seem to have generic information and not personalised info about my plan.

where do I look to find

1. how much coverage is left in my plan

2. how many times can I visit the dentist again

3. what exactly is my waiting period

4. what is my calendar year and

5. which are the clinics that are in network for my coverage?

I'm lost. would love some help pls

I have a marketplace plan with Sendero, a Central Texas nonprofit, which has been a little chaotic so far.

In January I had an ultrasound done for pelvic pain. I forgot to pay the bill and got a final notice, oops, but looking at it now I see that the two procedures are coded separately: 76856 (non-invasive pelvic ultrasound) and 76830 (transvaginal ultrasound). I'm reading conflicting info online about whether those codes are ever bundled, so I'm curious about that. Does it depend on the insurance company? Would that lower my out of pocket cost, or is it actually completely irrelevant to me?

I have to call Sendero anyway, but I'm dreading it, and their member portal doesn't work. so--it's not that big a deal, but if anyone happens to know, that would be great!

I'm trying to help a family member who's not very internet savvy. They were going through probation at work for a new job and they didn't realize they didn't fill out their medical insurance paperwork so they basically have no insurance . problem is he fainted at work and he was diagnosed with a heart problem at only 42 years old. He can't apply for Medicaid since he's in the process of sponsoring his wife through immigration .

what are his options ?

I'm in California so I don't know what's available to him in Texas.

Diagnosis: hypertrophic cardiomyopathy

List of medications:

1. currently on apixaban, but may switch to warfarin

2. metoprolol

3. mavacamten is what they want to add and is really expensive

I have Anthem. I had a negative Cologuard in February. Would a colonoscopy be covered if I wanted to do that also? Do I need to stop doing the Cologuard for three years and then do the colonoscopy screening?

I have Anthem Blue Cross insurance (HDHP/HSA) and recently had surgery with an In Network hospital and provider. The cost of the surgery maxxed out my deductible and OOP in one shot, so in theory I should be at $0 out of pocket (In Network) for the remainder of the year.

My surgery required several follow-up appointments. At first, these were correctly being processed as In Network. The last two visits, however, were treated as Out of Network and as a result I was sent a bill, because technically I haven't met my Out of Network deductible and max OOP.

I called Anthem and according to them, the only difference is the Out of Network claims were sent to them without the provider name (the MD name); only the hospital name. Therefore, their system appeared to default it to Out of Network. The previous claims which were correctly processed had the provider name attached.

My provider and hospital use MyChart.

Has anyone run into this problem?

So around end of 2025 I got on BlueCross Blue Shield insurance via my employer. I was able to get back on Medicaid in January. I could not find a way to cancel my BCBS so I finally was able to call in to my companies benefits hotline. They told me to file an appeal and I sent one in on March 27th. Today I called back into check and they said it was denied because I missed a 90 day deadline. It was supposed to have been by March 20th and I can't cancel now until annual enrollment in October or have a life change event. I have not used this insurance at all and its costing me money each paycheck. I lost my food stamps and am behind on rent and need all the money I can get. Is there any way I can appeal this? Is it in violation of any healthcare law?

My teeth are thankfully healthy and young.

I plan to go twice a year for cleaning and X-rays. I will do cavity fillings if needed.

My workplace does not offer dental insurance. Should I get dental insurance or self pay?

Edit: I called my current dental place and if I'm self paying, it is $120 cleaning and X-ray. The price will be higher for deep cleanings. And $110-250 for fillings.

I don’t know if I marked the correct flair.

I am a 19 year old female and needing to get an IUD. I have insurance as a dependent under Cigna PPO. I am not worried about billing, but I am concerned about where I can go to or how to determine what my insurance covers to go someplace that has a cheaper or covered IUD.

Does anyone have advice or information regarding this?

My husband just got a new job, and his benefits don’t hit until next month.

He has been having severe abdominal pain. He throws up if not every single time then almost every time he eats anything, and sometimes in that vomit there is blood. He has a bunch of physical knots in his stomach and abdominal region as well.

I know that he needs to go to the hospital but he doesn’t want to because he has no insurance.

They legally have to help him right?

I am self employed and 35 on a hdhp from the marketplace. Yearly oop max is like 8k. I want to go to rehab for drug use that I just can't seem to shake on my own. Would going to rehab increase my future rates? Am I better off just saying I don't have insurance? I probably won't use other health care services this year so it's not like I'll have to pay another 8k on other stuff.

My dental insurance, Dominion National, is a nightmare. That's for many reasons, but #1 is that their Find a Dentist lookup is completely wrong.

I searched for oral surgeons (I didn't have one yet) in a 20 mile radius that Dominion says will accept my specific plan. I called all of them. Literally only one actually accepts it (and they have horrific reviews).

Then I asked Dominion to provide me the real list of covered providers. They sent me the exact list I already had.

Called again and was given a wishy washy response about how the list may contain some inaccuracies. One or two is an inaccuracy. Virtually the entire list being made up is profound negligence.

The network covered by a plan is one of its most vital features. I always use the provider's lookups to check coverage breadth before selecting a plan. I did that for Dominion and thus signed up based on false information.

Are insurers allowed to simply lie about their network of providers? Do they have any legal obligation to maintain an accurate database? Is there some agency I can report this to? This seems insane even by the dismal standards of US insurers.

Long story short glasses broke after five years. Planned to buy glasses on line. Went into glasses place that offers eye exams been there before.

Walked in saying I only wanted the exam and prescription, everything okay until after exam. Forced to get cheap frames with my Health first/ Medicaid insurance.

They refused to give me my prescription until my glasses arrive in two weeks.

I know illegal but I still wanna buy glasses online without having the long wait. How do I find my eye prescription?

Currently enrolled in: Kaiser Permanente SCR $10 HMO EU 320

Hi everyone, I delivered our baby in July of 2025. I have not yet received the hospital bill and have been sticking to the same insurance plan because I've received mixed info about the OOP Max updating to whichever the current plan is. I'd love to switch to a lower monthly premium because aside from baby's visits we don't go to the doctor often. BUT if switching plans makes our OOP go up to 10 or 17K then I'd rather stick to our current plan capped at 5K.

Does anyone have experience navigating this?

(also it feels pretty ridiculous that we'd have to pay the current OOP instead of the one of the plan at the time of birth?)

I'm not sure if I should just call KP to ask if/when I'll receive the bill.

I saw my psychiatrist last week and was told my copay to see him is $100. Fine, $100 it is. Today I get an email and my insurance says I actually only needed to pay $50. Now I'm confused AND irritated.

Should I request a refund from my psychiatrist? $50 is a lot of money for me. Anyone have any idea why my psychiatrist told me $100 instead of $50? I didn't have a previous balance due.

Thanks for reading!