Hello, asking for a friend here. She is a US citizen currently living in Europe and returning to Florida to attend a detox/rehab center, on short notice. I assume no plan would cover her stay at the center but trying to help her get ACA or a short term plan for emergencies and routine visits while she is there. At the moment she is planning to stay 3-6 months but could be longer. She has preexisting conditions. I read that moving counts as a qualifying event, but since it is last minute I don't think she'll have proof of change of residence very soon though her mom could put her name on a few ..read more

In 2021, I had an X-ray and I'm covered by Medicaid in my state since I'm 18. I'm entitled to two X-rays a year until I turn 21, but my current dentist won't do another one until 2026. My Medicaid coverage might end next year( due to being sick and moving around a lot for school) and my wisdom teeth are causing me a lot of pain. The bottom ones were removed last year, but Medicaid refused to cover the removal of the top ones. Now a year later pain is so bad that some days it hurts to talk, and the area where they're growing in is white. The dentist said there's nothing to be done until 2026 ..read more

I am trying to understand why anyone would choose some of these very expensive insurance policies. I am currently changing jobs and the new employer does not offer benefits. After searching for a plan for several weeks for my family, I’m fairly sure that the best policy for us is this one, which also happens to be the cheapest. Keep in mind that I have a wife and two kids, and lets just assume that there are plenty of doctors in my area (NJ) and we are not too picky on which ones we receive care from. Amerihealth IHC Bronze EPO Silver HSA Advantage Premium - $380 per month (After tax credits ..read more

Hello, if you can please help or have any advice I would appreciate it a lot because I can not afford $7000 I am a college student in California and recently got into a bike accident. I chipped my front tooth and fractured 3 other teeth around it. I quickly went to the dentist and he wants me to get 4 crowns that would cost $7000. I have my primary insurance with my university (UC ship because I’m in California) and the medi-cal/medicaid as my secondary insurance. I already told the dentist that I can’t afford this and they recommended paying in installments or filling a claim with my health ..read more

Hey all, I don’t know if this is even the right place to ask this but I’ve tried every keyword I can think of on google and can’t find an answer. My wife’s employer offers health benefits even though the company is considered a “small business”. They have fewer than 50 full-time employees. Her employer has agreed that she can go to part-time (~20 hours/week) and still receive benefits. Her employer states that she doesn’t know how to track her hours because she believes she technically needs to work a minimum of 30 hours to receive benefits. Does her employer ultimately make the decision to i ..read more

I live in Maryland and have bcbs of Alabama. They denied coverage on an mri requested by a breast specialist because I have an undetermined mass inside my right breast. The thing is in the state of Maryland is illegal to charge a copayment or apply a deductible to any mri used to diagnose breast cancer. Bcbs is saying they don’t have to obey Maryland law. Any advice in what to do? They paid 100% of a diagnostic mammogram (also the law in Maryland) but they denied the MRI. submitted by /u/MrIrrelevant-sf [visit reddit] [comments ..read more

I have a question that I'm trying to navigate and it's a fairly unique situation. I'd appreciate any help or insight for what to do. I have 2 private health insurance policies (both HDHP) where I am the policyholder. My 1st policy has been in effect since 2023, my 2nd policy just started in April 2024. I am currently doing the coordination of benefits forms to let them know about each other, but from reading the regulations, my 1st policy will be the primary. My 2nd policy says COB does not apply to outpatient prescription drug section. I have a $6000 deductible at my 1st policy and a $5000 d ..read more

hi, so i'm shopping on the marketplace for insurance. i qualify for special enrollment. and just for example, one of plans has a $500 deductible, and for a specialist it says "in network: $50 per visit from day 1." so does this mean that if i go to a specialist I have to pay up to $500 out of my pocket, and then I would have met my deductible, so going forward all specialist visits will be $50? also, what if the specialist visit is $800 for example. so would the visit be $500 (deductible amount) + $50 (copay to pay for the rest of it)? I have another question(s) too. it also says for emergenc ..read more

There was an older post about this earlier from a few years ago, so I thought I would share my own research into this matter. If you are in network, per the CA Insurance Commissioner / Department of Insurance: Consumers can only be billed for their in-network cost-sharing (co-pays, co-insurance or deductible), when they use an in-network facility for non-emergency care. I read this as "you can't be charged admin fees if you are in-network." Someone please correct me if I'm wrong. https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm https://www.insurance.ca.gov ..read more

My daughter has a neuromuscular autoimmune disease that requires monthly home infusions. This has all been fine with my insurance for the last 7-8 months. Recently her dad also added her to his insurance policy, because layoffs were happening at my job and we wanted to make sure she was covered no matter what happens to either of our jobs. My insurance is primary, since my birthday comes first in the year (that’s how my insurance said it worked). However, his insurance is also trying to claim to be primary, so this month the pharmacy is refusing to send out the medication for the infusion sin ..read more