I took a $2,000 medical loan for the root canal, and now DentaQuest is not reimbursing me. They are asking me why I didn’t go to one of their in-network endodontists. The reason is that I was in severe pain, and it took DentaQuest 2-3 weeks to find an endodontist, but they couldn’t find one in time. I eventually had to take out the loan and get the procedure done on my own. Now , still waiting for the DentaQuest reimbursement .

**Location:** Birmingham, UK **Type of Insurance:** Home Insurance (Subsidence Claim) I'm sharing my experience dealing with what I believe is systemic fraud by Royal & Sun Alliance Insurance (RSA) and their loss adjusters, Crawford & Company. After 4.5 years of battling for a fair resolution to my subsidence claim, I've submitted a formal escalated criminal complaint to the Chief Ombudsman following their recent decision (PNX-5126400-B7P5, January 24, 2025). # Background In September 2020, I filed a subsidence claim with RSA. The Ombudsman has already acknowledged RSA's "shockingly poor service" and "significant avoidable delays" in their decision. However, my complaint goes much deeper than poor service. # The Evidence I've Gathered Over these years, I've collected substantial evidence of what appears to be deliberate misconduct: 1. **Fabricated Complaints**: RSA created three fake complaints (January 30, September 26, and December 7, 2024) to manipulate regulatory timelines and circumvent proper oversight. 2. **Falsified Technical Documents**: Key claim documents including the Schedule of Works (SOW), Certificate of Structural Adequacy (CoSA), and Forms of Acceptance (FOAs) appear to have been fabricated. Metadata analysis reveals these were created in 2024 but backdated to 2021. 3. **Data Protection Violations**: My Data Subject Access Request (DSAR) came back with approximately 73 critical documents fully redacted and many (around 50+) others improperly withheld. 4. **Claim Reference Manipulation**: RSA repeatedly changed my claim references (from SU2004338 to 1781135 to 202405326), seemingly to obscure the complaint history and make tracking impossible. 5. **Conflicts of Interest**: The person investigating my complaints at RSA was directly implicated in the issues I was complaining about. # Most Concerning Evidence What troubles me most is that when I examined the Certificate of Structural Adequacy, it falsely claimed that Leo Horsfield (the structural surveyor) recommended removing an ash tree that had already been felled two years before they were even involved in my case. This demonstrates deliberate falsification, not just an administrative error. Similarly, the Schedule of Works was created on April 30, 2024 (proven by metadata), yet RSA claimed it existed since July 2021. When challenged, they couldn't produce the original document. # Where Things Stand Now The Ombudsman's decision acknowledged the poor service but couldn't address the potential fraud due to their limited remit and outside timeframes of this particular complaint. I've now escalated to the Chief Ombudsman, with copies to the Financial Conduct Authority, Information Commissioner's Office, and Serious Fraud Office. My 122-page complaint (filed 02.03.2025) meticulously documents every falsified document, fabricated complaint, and regulatory breach with supporting evidence. I believe RSA's actions go beyond poor service into potentially criminal territory. # What I Hope For I'm sharing this to warn others and hopefully connect with people who may have experienced similar issues. I also hope that by bringing awareness to this case, the regulatory bodies will give it the serious attention it deserves. Has anyone else experienced anything like this with RSA or other insurers? Any advice on navigating this process would be greatly appreciated.

Got a crack on windshield recently and just found out there is no specific "Glass coverage" policy for me. What I'm trying to say is if I wanna use my insurance to replace the windshield then I need to use the main accident coverage or something to cover it and I have $1000 deductable since Safelite gives me a $1100 quote and if I use insurance it will make my rates higher in the future, so it's kinda worthless and means I have to pay the $1100 windshield by myself. I've heard some ppl have a specific glass coverage which means it will cover any glass replacement with 0 deductable and will not affect my rates. So my question it's the CA thing or did I just pick the bad company? I have Statefarm for now since it's the "No.1" insurance company and I just don't wanna any trouble if one day I have some damage and need to claim. If it's the company, any recommendations? Ty.

I bought a used 2012 Volvo during the pandemic at the height of used car prices out of desperation. I needed a car. I have $12600 left on the loan. The car itself is now valued at $4000. It currently requires $15000+ in repairs to pass safety and emissions. I’ve had nothing but problems with it since purchase a couple of years ago. I have put about $1500 into the car so far in repairs. I suspect I was sold a lemon, one shop suspected a history of flood damage, another refused to comment if that was a possibility. I do have gap insurance, not sure if that can apply here. I cannot afford to fix the vehicle or pay out the loan and get a new vehicle. Between the original dealer, the lender, State Farm, auto repair shops, I feel pretty constantly let down by customer service. I also struggle to understand all of the policies and legalese. Is there anything I can do here? I’m so overwhelmed.

My parents applied for health insurance through Maryland Health Connection, and were told they were eligible for an advanced premium tax credit. Now that they are doing their taxes, it appears that there was a large overestimation of the amount on the premium tax credit they were eligible for, resulting in them owing about $15,000 in taxes. If this is the fault of Maryland Health Connections for overestimating the amount on the premium tax credit they were eligible for, is there anything that can be done about this?

This might be a doozy, but here I go. Thank you advance. I decided to get my own insurance (so my insurance wouldn’t be tied to my job in the event of job loss). I searched in marketplace. I entered my criteria to find a plan that covers my PCP, my daughter’s pediatrician, and my medications. Marketplace found me a plan that covers it all and I enrolled in December to start in January. Today I had an appointment with my PCP. As I checked in, I handed them my insurance card, and they let me know he was not in network. Which is WEIRD considering I made sure I picked a plan that he was in. I left and called my insurance. They told me he was in network. They confirmed his address and phone number - it was incorrect. It was his old hospital from over two years ago. I gave them the new information. She left me on hold for a while and came back and apologized, saying he was NOT in network with my current plan. She said since I got my insurance through marketplace, I need to contact them. So she transferred me to marketplace. I’m now on the phone with marketplace. I speak to the representative (who was clearly in a bad mood) and he had no idea what was going on so I had to explain the situation again. He put me on hold and when he comes back, he says that he’s not sure why I’m talking to them when I should be on the phone with BCBS. I told him that I got insurance through marketplace, and I only picked my plan because it was in network with my doctor, which was clearly incorrect! He said that I was not entitled to 100% accurate information on marketplace and it was my duty to double check to make sure my doctor was in network. Which, according to BCBS, he WAS! At his OLD PRACTICE. From two years ago. And he is not now. I asked about changing my plan so I can actually see my physician and he said open enrollment was over and I would have to qualify for special enrollment which we could not do today. He told me to call BCBS again. I call BCBS again and the new CSR I spoke to was even worse. She basically told me to call marketplace. I told her what they told me and she said that was incorrect information and it was up to them. I am on the verge of tears right now. I’m playing this back and forth and I don’t know what to do. Do I make a complaint with marketplace? How do I go about it? None of this is my fault but they’re either blaming each other or blaming me. I just want to see my doctor, man. TLDR: got insurance, was told he was in network, turns out he isn’t in network because of incorrect address on file, and now I’m trapped in a limbo with BCBS and Marketplace and no one is being helpful. ETA - unsure if this is relevant in this situation, but I am 32, in Oklahoma, and gross income is over 100k. Maybe 140.

I have BCBS Horizon of NJ PPO. It’s my dad’s plan thru his work at a large sales company that has no religious affiliation. He’s worked there only a few years definitely after 2019. His job is in NC, I’m a MD resident. Currently battling insurance for a bilateral salpingectomy which is a form of permanent contraceptive and falls under preventive care and the ACA. My plan offers preventive care 100% covered in network. My insurance is telling me it’s covered at 80% after my deductible is met ($1200). One rep even told me my plan must not be aca compliant then. I looked into that and BCBS NJ horizon has not offered a non aca compliant plan since 2013. This rep is flat out lying, right? Well she gets a supervisor involved and he can’t confidently say whether my plan is aca compliant or not. It covers birth control 100% (I currently am on a 100% covered by them birth control). I think they may be looking it up as an outpatient surgery and not as preventative care. How do I tell them to look at it from preventative care and not outpatient surgery? Is it even possible for my plan to not be aca compliant? I’m currently in communication with an hr person from my dad’s company. She hasn’t gotten back to me yet and I really want to sleep tonight. My surgery is March 27th and I really can’t afford for it to not be 100% covered. Please help 🙏 💜

Is it even legal for Healthy Paws pet insurance to increase premiums at almost 200% in CA? This is outrageously high!! Anyone experiencing the same? #healthypawspetinsurance

i visited the ED back in march 2024 and ended up being placed in observation and let go the next day. i’ve been dealing with an insurance/billing issue since then. i have anthem BCBS under an employee sponsored health plan (Union Construction Workers). the hospital i visited was In Network. for some reason, the hospital is billing me around 17000$, stating that my claim was denied due to code *00897, which requests complete medical history from the member. the member being myself, so i contact my employer sponsored health plan claims specialist, and she has no idea “why they would want that [referring to medical history]” and ensures me the claim is covered and sends over the EOB. which states patient responsibility is $1500, and not $17000. she lets me know that UCW paid mercy back in july. anyway, fast forward to november i am getting billed $17000 again. i call billing, they escalate my case, and remove the $17000 charge from my statement. i call UCW again, and they let me know the claim has been paid. billing is telling me anthem denied the claim again. they ask me to resend the EOB. fast forward to now, i am getting billed 17000$ AGAIN! i call billing, they tell me that the anthem claim is denied. i ask them if they looked at the EOB. they say yes, i ask them if we can go through the EOB together. we look through my UCW EOB and the billing employee states that my ANTHEM EOB was reviewed and for some reason my UCW EOB was not reviewed but it was received after i sent it in November. he agrees, i should only owe $1500 per the UCW EOB. but anthem is denying my claim still. i call UCW again. the rep tells me that she is now contacting anthem directly. after 9 months of issues we are finally contacting anthem. and there is no way for myself to contact anthem, only through the UCW representative. i am giving birth in about a month, im in a rush to get this handled. i would accept any help that i can. i have looked through the itemized bill, UCW EOB, and claim on anthems website and reviewed for errors. i noticed that there is one charge (for $9.50) that insurance covered that is listen on both the itemized bill and anthems claim, however not listed at all on the UCW EOB. but i, a not insurance expert, does not know what this means. please please help if you can! i have already talked to my states insurance department, which they were confused w my situation and could not help. i also have requested proof of payment from UCW, as well as a 3 way phone call between UCW, myself, and billing.

Location: Tennessee My wife (German) and I (US) bought tickets from the US to Canada with Costco Travel before things got rough. My wife still has her maiden name on her passport and my last name on her green card. We have both abided by the law and have no criminal history. It is a bit scary seeing Germans and other EU citizens detained in such traumatic ways, and I do not want my wife going through the same process. We cannot get our money back as the insurance does not offer refunds and Costco cannot offer any refunds on anything but Air Canada flights, which must have an end destination in Canada. Right now, I have a few options, but I would love to see what type of risk we would be taking here if we decided to go anyway. We really can’t afford to throw away that money, and it might be the risk is rather low. 1. I am contacting the German embassy to make a statement on her passport in relation to her green card. 2. I am contacting my credit card company to see if get a refund. I know some offer travel benefits and protection. 3. Get the refund for Air Canada and use those credits for visiting my wife’s family later through Canada. The downside is I would have to buy more flight tickets in a recessionary environment. We would love to change it to a domestic trip, but is there anything I can do to get my money back or make it safer to travel to Canada and back into the US