My mom’s home insurance policy looked high so I called the insurance company and asked them to walk me through it. Without changing any of the coverage/details, they determined it was thousands higher than it should be and couldn’t explain why. When I asked about a refund they said they could refund a few hundred dollars (she overpaid by thousands for this year). The policy renews in October so I’m assuming this is a prorated amount, is this expected? Again, the coverage details did not change and they can’t explain why it’s that high. At the very least, shouldn’t she be refunded by how much she overpaid for this year? I need to dig through my parents’ paperwork but it looks like this has been happening for years.

I hope the flair is correct. So I have Aetna POS II through my employer and my prescriptions are handled through OptumRX. I previously had Cigna health insurance for 2024 and was forced to Aetna cause plans changed and this was the cheapest one (even though it’s not cheap) I had an auth for Zepbound valid until 3/16/25 that was initiated in September 2024. Well my provider submitted a new auth and it was denied. Optum is telling me it’s my health insurances problem. Then Aetna tells me they have no control, contact Optum. My provider is supposed to submit an appeal but I’m feeling really confused. Who has control over the prescriptions then? How have I gotten two refills since January even with my health insurance changing? (Optum rx has not changed and I had them in 2024 too) Can anyone help me understand?

Hi, my parked car was scratched up on the side by a charter bus a couple months ago. A witness left a note with their number stating that they can send me the license plate photo. They seemed very willing to help and agreeable to making a statement if needed. I had opened a claim with the bus’ insurance company and sent the agent text screenshots of the correspondence with the witness. Weeks later the agent informed me they couldn’t get in touch with the witness and issued a denial because of that. I texted the witness and asked if they could follow up with the agent and was met with no answer twice a couple weeks apart. Is there any other form of proof that I could present to strengthen my case? Thanks in advance!

I’ve tried meds and special bland food and the dog is still scratching excessively. I got a quote for testing at like $1500 plus a $300 consultation fee. Was wondering if anyone knows if this is covered. When I called nationwide they were very vague, saying it depends and they can’t guarantee if it’s covered. Smh

I live in Minnesota where insurance companies are required to cover 48 hours of inpatient care after a vaginal birth. https://www.revisor.mn.gov/statutes/cite/62A.0411#:~:text=Every%20health%20plan%20must%20provide,a%20mother%20and%20her%20newborn. My insurance (Medica) is trying to make me pay $1850 of the $8300 billed to them for room and board after I gave birth. The stay was less than 48 hours. Is this legal? Do I have a course of action here?

Location: Dallas, TX. I was out of town in November, and my vehicle was being driven by my housesitter, who was involved in an incident where (I believe) the other driver was at fault. She stated she was sitting at a four-way stop when it was her turn to move forward and a driver came through the intersection without stopping and swiped the side of my vehicle. He provided to her his drivers license and car insurance information at the time of the incident. When I returned from my trip, I filed a claim with his insurance, which was USAA. No police report was filed. I have insurance through Texas Farm Bureau but liability only with a 1k deductible. The first agent I worked with at USAA was completely unresponsive, I reached out multiple times to her over the course of several weeks before I had any follow up and had to escalate my claim to a manager. Finally, a second agent was assigned. The second agent originally told me that, based on the first agent’s notes, the claim would be closed in my favor, she just needed to verify with her manager because no one had been able to contact the driver. The next time we spoke, however, she said they needed to speak with the driver to verify events before they could close the claim. Basically, over the course of several months, the driver refused to contact USAA or speak with them about the claim. According to the agent, they sent several letters and calls. I’ve just received a denial letter from USAA and the advice from the new agent is that I file a claim with my insurance and they can try to recoup any monies from USAA; however, I’ll basically just be paying out of pocket bc of my 1k deductible and liability coverage. I haven’t gotten an estimate on my vehicle yet but the damage doesn’t seem extensive, I would think maybe $1000-1300 in repairs; however, much more than I can afford. Do I have any recourse to get this handled with USAA? Updated to add paragraph breaks. :) Also updated to say I will double check with my agent about my policy tomorrow (they're closed now). I thought I had liability with a 1k deductible but I'll double check on whether or not thats for collision coverage. I looked at my policy documents and I can't tell what I have... Thanks for all the help !

We recently had to file our first homeowners insurance claim in the 6 years we’ve owned our house. We had a huge storm with 75+ mph winds and torrential rains, tornadoes etc. We randomly had the wood paneling in our living room (interior wall, other side is a bedroom) sustain water damage. It was wet and mushy and all warped. We want it fixed because we don’t want mold growing etc. roof is 4 years old so we aren’t sure how water got in. We also need a professional to figure out how this happened. Anyway, State Farm says it’s covered under our policy. We have a $3,000 deductible. They said they deduct the deductible from the money they send us for the repairs. We don’t pay it up front. (We are waiting for a callback from the contractor they helped us find). To me that sounds like if it’s going to cost $6,000 to fix they take off $3k and we only get $3k. My husband thinks we get the full amount for the repairs which makes no sense to me. State farm has to pay themselves the deductible. We had a total loss on a car last year and they took the deductible out of that and we got less money back for our payment. So that’s why I think we aren’t going to get the full amount (which is not going to be helpful we don’t have a ton of money right now). So anyone know who’s right?

I got a new puppy (7 weeks old). Got embrace pet insurance that same day. Took her in for her first vet appointment as a good pet owner should about a week later. Obviously this was still during the illness waiting period. But it appeared I had a nice healthy puppy. Turns out she has a heart murmur. First vet graded it as a grade 4 and told me to see a cardiologist. I went and got a second opinion and they graded it as a grade 3 and we are going to watch it and see if it goes away in the next couple months. Anyway, embrace pulled the SOAP notes from the 2 vets and are saying it's not covered as it's a preexisting condition. I plan on appealing it, even going to the California insurance board or whatever it's called if I have to because it seems like that is such BS. I'm being punished for taking my pup to the vet too soon. My question is, what is the best way to word the appeal to the embrace adjuster? It's not right that an 8 week old puppy getting it's very first exam should get that classified as a preexisting condition.

I got a MRI done two weeks ago. When I scheduled the appointment the staff told me they didn’t know the amount to be billed since my insurance is a high yield deductible and no copay. They mentioned that if I want to pay out of pocket without using my insurance it would be $500. Fast forward I received a processed claim from Aetna saying that I need to pay $920 and that the X-ray company billed them $1,200. Is there any way to reverse this? I feel scammed by both the X-ray company and Aetna. Can I fight back a processed claim?

My car was parked and hit by an amazon delivery truck. They were delivering packages to either my apartment or one next door. He side swiped my car leaving the parking lot. Luckily a person saw and tried to flag him down and he sped off and drove off. The witness then reported it to my apartment management who got the video footage from their surveillance cameras. I have the photos of the amazon truck hitting my car, a clear view of his license plate, a witness, and a police report (although the policeman said he couldnt read the state on the plate but i figured that out later and gave it to my insurance so it might not be in the report). I called amazon and got two different reps who barely spoke english. I ended up calling my insurance (state farm) and they were great and said i should do a claim as typically this doesnt affect premiums. After i initiated the claim last week, yesterday i finally got a call back from amazon who said a rep from ARC, their dedicated claims (third party?) company, would reach out next week. I researched ARC and all the reviews are awful. Everyone says they lowball you and take months to settle. Should i just go through with the claim with state farm? I havent gotten any estimates yet. And my rep for state farm said this would likely not raise my rates. But im guessing the fix will be several thousand for a new fender and bumper and maybe wheel rim. I havent had a claim in 10 years and felt good about that, but just wanna make sure im not doing this wrong. Thanks.