I was referred by my PCP to a physical therapist and was going regularly to appointments where I was only charged a $15 copay. However, after one of my appointments where my PT used a new technique (biofeedback training), my insurance is saying that service is denied and trying to charge me upwards of $400 for this one appointment. My insurance provider is United Healthcare. When I go to their website and try to "estimate cost" of this procedure (code #90912) it says that it should be covered by my $15 copay. However, when I called United to ask why it was denied, they said that there was a form called a PRA that they sent to my provider and it was not returned, so they didn't have enough information and denied it. I was told by the provider, my PT, that she never got this form and I also reached out to the billing department for the medical group, Sutter, to have them try and follow up with insurance or look into it, and was told that they would and I'd hear back within 30-45 days. Now my insurance is saying that, since they denied my first appeal, I only had so long to appeal that and the deadline is approaching. The "patient advocate" told me that either myself or the provider has to write a letter to United Healthcare Escalation center and ask for a secondary appeal, but was super vague on what exactly to say or write. I called back Sutter, since it had taken so long. They said they had 30-45 "business days" to review it, but they'd mark it as highest priority. I don't think I should wait for them, but am unsure what exactly I can say to get United to resend these forms that my provider says she never received. Any guidance?

Got into a crash in the state of FL, parked in a parking spot and had to realign myself to be straight. The parking spots are aligned at a 45 degree angle. I reversed just enough that my rear wheels were visible, there was no vehicle next to me parked that could’ve potentially been blocking the vision of my vehicle, I was in the travel lane and as I was about to shift into drive, a vehicle driving westbound hit me in my rear-end and spun me around facing the opposite direction of travel, the whole back end of my vehicle is smashed in and not drive-able. It’s a 15mph travel zone and safe to say nobody drives 15mph through this spot. The damage of my vehicle definitely looks like more like 25-30mph. Cops talked to me and other driver but in the written statement wrote that I was reversing and then got hit which wasn’t true. Also said that it’s a no-fault state and so she could’ve written me a ticket. I’ve only had the car for barely a month and paid $3k for it, I have progressive insurance at the state-minimum required. After the crash my back and shoulder hurt. I just want to know what can I do, any help is really appreciated because I need a new car as soon as possible. Location: Florida

Hi everyone, I'm on the phone with the claims department at MetLife. After having paid faithfully for my dog's insurance since the night I adopted him for two years, when I finally filed my claims, I've received SIXTEEN CENTS. Two years worth of payments for SIXTEEN CENTS. They are denying part of my claim because they said I need to provide the previous 12 months of medical records of my dog's history before November 2022. The problem? I ADOPTED HIM IN NOVEMBER 2022. I could see if they were confused about that, but they were on the phone with me during the adoption process! I have a second dog, and I have a different insurance through them, and I planned on going with them, but MetLife gave me a good rate, and the rescue was so encouraging that I went with them, against my better judgment. Now I know why- they suck. I am looking for other people who've been asked for the same asinine requirements of producing their adopted dog's previous 12 months of SOAP notes BEFORE you adopted them and were denied for a claim. I'm looking to either send this to my state's AG or see if there's an attorney out there willing to take on a class action. Clearly, MetLife Pet insurance is a scam agency. I've asked them yet again to reimburse me, and I told them this time, if they say no, then I want all my payments returned. It's an easy decision- pay less for my claim, or pay more and give me back all my money. I also told them if they do, I'm willing to return the 16 cent paper check I made them mail me. Thanks.

I am getting some MRI's done at a outpatient facility and wanted to get an estimate by my insurance on my copay. My insurance asked me to get the NPI /taxid for the radiologist that will be doing the MRI so they can get the best estimate. I have BCBS I contacted the outpatient facility (NJ imaging network), and they gave me an NPI number but thats the NPI nubmer of the facility. I asked for NPI number of the radiologist, but they said that they bill under the facility, not the radiologist. How am I supposed to get an accurate estimate here? Also by "provider" billing I mean physician billing

Here's the situation: **The unit below me reported ongoing water damage on their ceiling/wall.** The building paid a plumber to do an investigation. After many hours, they were able to determine there was water coming from my toilet. I brought in my own plumber and he figured out there was a leak inside the wall where the toilet connects to the pipe (its a wall mount toilet and the gasket wasn't forming a tight seal with the pipe). This toilet pre-dates my ownership, if that matters. I had him fix it and paid him. Obviously the apartment below has repair costs. I immediately engaged a claim with my homeowner policy provider (Travellers), sent them the plumbers reports (both mine and the building), the by-laws of the building, and put my insurance in touch with the owners of the below unit. Fast forward, after some research, **my claim person says 'I'm not liable because there was no way for me to know about the leak, so the owners of the below unit should file with their insurance'** It is true there was no visible leak or damage in my apartment. Now the unit below me sent me an estimate from their contractor and says 'As you’ll see, they have denied the claim, stating there was “no evidence of neglect” on your part. **Given the damages I sustained, I need to understand how you intend to address this situation and take responsibility for the repairs.**' It's not clear if they've filed with their insurance. The husband and wife don't always seem to be on the same page. They are claiming repairs cost $30,000! I don't know how much of this is really related to the damage, as they are also in the midst of a major reno and might be using this to pay for some of that on the sly. I don't have a relationship with them. To clarify the leak was a long slow drip, which only occurred when the toilet flushed, which is why it took so long for the building plumbers to track down. Regardless, it seems weird to me that the insurance judges I'm not liable, just because I couldn't know about the problem. Especially since the policy seems to explicitly cover damage from water seepage where the insured is unaware because its hidden in a wall (in the DOES NOT COVER section for liability it says: CONTINUOUS OR REPEATED SEEPAGE OR LEAKAGE OF WATER OR STEAM OVER A PERIOD OF TIME, WEEKS, MONTHS, OR YEARS, FROM WITHIN A PLUMBING, DRAINAGE, HEATING, AIR CONDITIONING,SYSTEM OR AUTOMATIC FIRE PROTECTIVE SPRINKLER SYSTEM OR FROM WITHIN A HOUSEHOLD APPLIANCE **UNLESS SUCH SEEPAGE OR LEAKAGE OF WATER OR STEAM AND THE RESULTING DAMAGE ARE UNKNOWN TO ALL insureds AND ARE HIDDEN WITHIN THE WALLS OR CEILINGS OR BENEATH THE FLOORS OR ABOVE THE CEILINGS OF A STRUCTURE**). **Right now I'm waiting for response from my insurer and also the apartment below** (to see if they have filed with their insurer and if that insurer is in contact with mine). Up until now my interactions on this issue with the apartment below have been pretty even tempered, but their latest email feels like they are escalating and I'm concerned I might even need a lawyer (I live in NYC btw). (added highlights to help with TLDR)

Hi all — I’m following up on a post I made over a year ago regarding a dispute with my former neighbor in an HOA community: [Original Post](https://www.reddit.com/r/legaladvice/comments/17kskaq/neighbor_wants_us_to_remove_trees_trench_and/) At the time, the neighbor was demanding that I remove trees and trench my property due to alleged view obstruction and root intrusion. I consulted with an attorney back then who told me to wait and see if the neighbor actually filed a lawsuit, as the demands seemed like a scare tactic. Their advice was to assume he might just be bluffing unless I was formally served. **Fast forward:** I sold the property and moved out of the HOA community. A few weeks **after the sale was finalized**, I was served with a lawsuit from the same neighbor. The lawsuit includes eight causes of action, mostly related to HOA CC&R violations, nuisance, and alleged property damage from tree roots. **The plaintiff is still a member of the HOA. I am not.** I no longer owned the property and was not a member of the HOA when the lawsuit was filed. **My homeowner’s insurance is providing a defense attorney that will be defending me wholly but will only financially cover the property damage claims.** They will not cover any claims related to HOA CC&R violations, "loss of enjoyment," nuisance, or attorneys’ fees. The claims adjuster also told me that I could be responsible for the plaintiff’s full attorneys’ fees if he prevails on **any portion** of the case, even a minor claim. They are pointing to this clause in the HOA CC&Rs: *(i) Attorneys Fees.* *Any judgment rendered in any action or proceeding pursuant to this Declaration shall include a sum for attorneys’ fees in such amount as the court or arbitrator, as applicable, may deem reasonable, in favor of the prevailing party...* # 🔹 What I’m really trying to understand: Does the HOA’s CC&Rs and this attorneys’ fee provision still apply to me, even though: * I was **not a member of the HOA** at the time the lawsuit was filed. * I had already **sold the home** and was no longer bound by the CC&Rs. * **The HOA did not have any open or pending violations against me at the time of the sale.** * The claims are mostly based on alleged violations while I lived there. Is it common or even legally valid for CC&R provisions to be enforced against a **former homeowner**, when the lawsuit was filed after the sale? **Has anyone dealt with a similar situation?** Any legal insight, personal experience, or thoughts would be really appreciated. I’m trying to gauge how much personal exposure I truly have beyond what my insurance is covering. *(I understand this is not formal legal advice, just looking for shared experiences and general guidance.)* Location: California

With all the posts regarding Healthy Paws rate increase I was worried about my renewal. I am happy to saw that I just received it and it has not increased. It is staying the same at the moment. However, I will wait to see because a couple years ago there was a discrepancy and in August they sent me a new notice increasing me by $20. Fingers crossed that does not happen again. I was expecting a huge increase living in NYC.

I pay into a CalSavers account. I received an email five days ago saying: "per my request all correspondence will be sent to:" \[an email which is not mine\]. It looks like a scammer domain. I don't remember registering to access the account on the CalSavers website, though I may have during the enrollment process when I started the job. Either way, I can't access the account as it doesn't recognize the email I would have used. Is it possible someone has stolen the money by transferring it out of my account? I don't imagine scammers would waste time as soon as they have access... I can't call CalSavers until their office opens tomorrow.

My car was hit by someone who took responsibility for the accident. We went through their insurance company and took the car to the repair shop they recommended. While at the shop, they doubled the estimate of the repair work leaving the car disassembled, as the insurance company wanted to declare it a total loss. I told the insurance company to work out the financial settlement with the finance company, as the loan was still larger than the value. The finance company sent the insurance company a letter of guarantee and I signed the DNV documents transferring ownership to the insurance company. The insurance company then deducted the salvage cost from the settlement and said they would tow the vehicle to my home. This is not a vehicle I want or agreed to retain, as the vehicle is not currently drivable, and the effort to make it so is not in my best financial interest. They are attempting to force the vehicle back into my possession. Is there anything I can do to prevent them from forcing me to retain possession of the vehicle, given they have the signed documents necessary to transfer ownership once the lien is paid? This is CA and the insurance company is AAA. 

Hi everyone, I wanted to share my experience with biBERK workers' comp insurance and get some advice or feedback from others who may have dealt with something similar. I had a workers' comp policy with biBERK that was fully paid and I canceled a few days before the expiration date. A few weeks after cancellation, I received an audit request. I didn’t fill out the forms right away, and shortly after, I got an email saying I owed around $500 as an estimated audit charge since the forms hadn’t been submitted. I called biBERK to ask about it, and the agent told me that if I filled out the audit forms, they’d be able to issue a proper audit and adjust the premium based on actual payroll. I submitted the audit form the next day. To my surprise, after submitting the audit, the amount due increased to $1,300. I called again and was told I could submit a formal dispute, which I did. I explained that: I’m a small business with only one employee on payroll. The policy was canceled early, before the full term. No claims were ever filed. I submitted the audit forms in good faith expecting a fair adjustment—not a higher charge. Today I received the outcome of the dispute, and they only reduced the bill by $77—so I still owe $1,223. I’m feeling frustrated and a bit taken advantage of, especially since the audit estimate was originally much lower and I submitted accurate data as requested. Has anyone dealt with something like this before? Is there any recourse or further steps I can take? I appreciate any advice or insight.