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Lemonade - Lemonade denied claim, should I appeal?
Hey denied my cat’s mycoplasma diagnosis because his first vet record shows he was sneezing (self report by us.) however, he is a Persian and they tend to sneeze for no reason. The sneezing he was doing when he got sick was WAY different than just a smelling around sneeze.
Now they’re saying it’s a preexisting condition when it’s not! (It was a bacterial infection, he didn’t have it when we got him for sure).
We got him in December and he got his cold in February.
I’m so upset and really regretting getting Lemonade
USAA - $500 policy increase in MA
My policy just renewed this month, my overall policy went from $2300 to over $2800. I had an accident back in 2023, very minor rear end tap. (I was at fault) the other party didn’t bring litigation against me until 2 months before the statute of limitations went up this year in april. My insurance company did pay out the settlement, and I was told I did not have a surcharge from this incident, and that if my insurance was to go up from this accident it would have happened in 2023 when the accident occurred. My insurance company (USAA) informed me of a state-wide increase being put into effect and that this increase on this renewal was only a portion of the overall increase. I’m just very confused, and unsure how it would increase that much if it wasn’t from this prior accident, and my driving record outside of it is totally clean. Been with this ins company for 6 years now, and I don’t want to switch as i’ve enjoyed it thus far but feel like I have to now that i’m being priced out of it. anyone in massachusetts have any insights?
United Healthcare - Prior Authorization Question
Hey all,
I’ve been having issues with my insurance trying to approve a surgery. My surgeon submitted a prior authorization and they denied it. They resubmitted it with a different diagnosis to meet the criteria. They usually take 5-10 business days. But within 48 hours I checked my UHC account and it said “cancelled”. What does it mean when it’s been “cancelled” and not actually denied?
I have United Healthcare through my mom’s work.
Thanks!
Spot - Pet insurance for 2 puppies
I’ve been scrolling this thread trying to find the best option for mine and my husband’s dogs but it seems every option sucks. We have a 7 month old rat terrier and a 10-12 week old husky mix (not positive on age or breed as we just got her and she was abandoned by previous owner). I looked at spot but all the reviews are terrible, same with ASPCA. My biggest concern is the cost of preventative care like vaccines. Both are due for vaccines and I’m hoping to find a way to lower the cost somehow. Someone please point me in the right direction 😅
Allstate - Allstate reversed liab over 1 year later..
Friend was in a MVA where she was going straight, CV was coming down driveway. CV did not stop, was given citation for reckless driving. She was injured, sought normal treatment. Ambulance/ER/PT/some testing. She had wage loss. VA is the state. Allstate found their insured 100% AF. Zoom forward over a year, 7 months out from SOL in VA. Demand got sent. 1 month after demand sent, Allstate changes liab states 'obtained data' speeding at 12.8 mph over limit on our side. That REALLY is not adding up for this road. There were no skid marks and she slowed down and moved into the other lane trying to avoid but the guy never looked... The PR shows she was doing the speed limit, however, the officer did not arrive or witness any speed. The other guy admitted it was his fault on the scene, but by the time he was being given the citation his fam was there insisting she was speeding(they didn't even see the accident... would be biased anyways). I find it mighty fishy it would take this long for any process to be started on an EDR and I work in insurance, I've never even seen a claim where EDR was pulled on a personal auto. I don't know how they obtained any data bc at this late in the claim I think chain of custody would be an issue and also the extraction method. I'm not sure where that vehicle has been bc it was a TL. Since VA is pure contributory, now with the reversal it's heading to our insurance, which is fine, we had the coverages. The issue lies with the pure contributory. If our insurance also finds the same, they could deny as well is my understanding. I doubt they will, but it's still quite concerning. How is this not a bad faith claim? Doesn't the VA statute say they would have to get permission to access that type of data? Don't they have to be forthcoming on how they obtained that data? This is a very weird situation and could end up costing a lot of money if both ins companies end up denying liab. Allstate already paid for the TL a long time ago. My understanding is even if the title was signed over, the VA statute states they can't access without request since they are an insurer and not using the vehicle for daily routine use. I'm not 100% they pulled EDR, but I can't figure out anything else that makes sense with that verbiage they are delivering. Any ideas?
Blue Cross Blue Shield - Need surgery- as of YESTERDAY hospital stopped contracting with BCBS
I recently had a life event (job) that allowed me to change my plan. I chose blue cross blue shield options, because the doctor I need to get a surgery from is in network with them! As of yesterday the hospital in Dallas is not in contract with blue health blue shield anymore.... would this be enough to qualify for another life changing event? This doctor is one of the few specialists that preform this micro nerve surgery. I heard soemtimes hospitals and insurance companies come to agreement and they will start accepting my insurnace again.
Embrace - State Based Premium Increases
I have recently had a 117% premium increase from Embrace. One of their justifications was the state I lived in, CA. I’m curious what other states have had such egregious increases ( regardless of company).
Healthy Paws - Dog Insurance
Hello!
I have a 4 year old dog and I am looking to change my policy from healthy paws. I think they're great but I hate that I have to pay for yearly vaccinations/checkups and dont get re imbursed. Any recommendations for a good insurance that has a low deductible and will reimburse annual exams which include vaccinations, possible dental care and flea meds?
Thanks in advance!
BCBS Anthem - Just got rejected approval from BCBS Anthem for surgery. Appeal likelihood?
I’m in shambles. A surgery out of network I was approved actually late last year is somehow now denied in network now? And the record of approval is nowhere to be found?? Literally saw it three weeks ago.
I want to make sure this appeal hits the ball out of the park with all necessary info but it’s such an uphill mountain and I was so happy for a month and a half excitedly waiting for my surgery next month.
Please help.
UnitedHealthcare - Question about needing a referral for healthcare to see a specialist
I have pathology reports from Hospital A that I received under a charity care arrangement. They are for dermatology. The reports revealed skin cancer and I needed surgery, but the hospital fused to allow me to use their charity care for the surgery
I might be taking a low wage job to try and get private employer group PPO health benefits. But the plan would be with UHC. If I already have the biopsy reports showing biopsy #1, biopsy #2, biopsy #3, biopsy #4 are basal cells and they require Mohs surgery, do I still have to wait months to set up an appointment with a dermatologist and then WAIT for a referral to see a Mohs specialist?
Forget about the prior dermatologist who did the biopsies. He works for a large healthcare system that won't allow him to refer me outside of their network.
If I literally have the pathology biopsies, can't a potential UHC in-network Mohs surgeon's office use that? Or does UHC ppo private group plan insurance and the participating Mohs doctor under UHC insurance require another dermatology referral, which would mean I'd have to wait many months just for that and delay the surgery I desperately need.
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