What am I missing here? It looks like Anthem BCBS is acknowledging my provider is in-network and then processing it as out-of-network. * Provider has been processed as in-network for visits both before and after the visit in question, always with a $30 copay and no balance. This was another routine, non-emergency visit with the exact same provider. * EOB clearly says in big bold print that "Going to this doctor uses in-network benefits" and elsewhere has the words "(in your plan)" after the provider's name. * EOB shows no copay, a portion applied to my deductible, and a balance in the "Your total cost" column. * EOB gives a reason code: "015: The amount shown here is more than your plan allows for this care. If this was not an emergency, the doctor/facility might bill you for the difference between what your plan allowed and what the doctor/facility charged." How is this possible for an in-network provider? It seems this EOB is just contradictory on its face. I've been trying to get them to fix it, but haven't had any success yet. Any advice?

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

Looking for advice on dealing with an insurance dispute with prior insurance company. In July 2023, a hailstorm damaged my home’s Structural Insulated Panels (SIPs) that had rolled roofing on them. Company initially agreed the panels needed replacement because rolled roofing couldn’t be reapplied per manufacturer installation guidelines. They first classified it under Ordinance or Law (ORD) coverage. Later, they changed their stance, saying it wasn’t ORD, but still wouldn’t move it under Dwelling Coverage. They paid $5k but refused to pay the remaining $8,606 for full replacement. Key points: • Manufacturer guidelines require panels to be clean and debris-free before rolled roofing can be reinstalled — which wasn’t the case after removal. • During demo, water intrusion was found. FBFS says they don’t cover “water seepage,” but there’s no proof it existed pre-storm. • Multiple adjusters were involved. Insurance company hasn’t provided their “expert” who allegedly inspected the panels. • Delays in their claim process (over 1.5 years) worsened the damage. At this point, I’m debating whether to send a letter of intent (basically putting them on notice before litigation) to try and get the $8,606 paid, or just go straight to filing a lawsuit for breach of contract/bad faith. The whole panels had to be replaced because rolled roofing couldn't be reinstalled and needing to get the roof back to pre storm condition. The water intrusion found 1.5 years later has nothing really to do with the initial insurance coverage in my opinion. Has anyone dealt with this or a similar situation? Did sending a letter of intent work, or did you have to sue to get results? Will they say fine okay it'll cost us more if we do get sued even if we win and decide to pay the $8606 instead? Next, even though they closed the claim, I'm filling another complaint with the states department of insurance.

Ok so this is totally my fault for not reading the policy documents, but the Trupanion deductibles are PER CONDITION, not annual. This means every time your puppy visits for a new condition, the $500 restarts. The idea is that once the deductible for a condition is met, your pet is covered for life for that condition without having to meet deductibles again. Our puppy had splinters stuck in his tonsils and had to be sedated to have them removed. The total bill was $750, and between "examination fees" and the new $500 deductible (we have already submitted claims for other things), nothing was covered. Here is the kicker, they not only didn't cover the examination/consultation fee, they also denied the "esophageal examination" which was the procedure to pull splinters out because of the word "examination". Here is ANOTHER kicker, if something gets stuck in his throat again, it would be considered a separate incidence, so the $500 will restart again! If your puppy gets giardia, it clears up, and he gets it again in 3 months, guess what, the $500 restarts! I can see that this would be a good policy for older pets with chronic conditions, so you don't need to meet deductibles every year, but for a healthy puppy who gets into accidents from time to time, every incidence is considered separately, so mostly likely much of your expense will not be covered! I'm switching back to another insurance that my 5 year old girl is on. I wanted to try Trupanion because I kept seeing ads for it, but now I'm going to switch both of my pups to be with the same company while my puppy is still young before "pre-existing conditions" develop.

Can anyone give me tips on how my Ucare/DentaQuest can cover my teenagers braces because she has a very wide noticeable gap on her teeth from the fact that she was born with an extra tooth and had to get it removed and rarely smiles with her teeth anymore. She’s done 2 orthodontic evaluations for them and they keep denying her but she really does need them and that’s all she’s asking for her birthday this month but they keep telling me she needs a medical reason or doesn’t fit the certain conditions they approve but I can’t afford to pay them out of pocket.

I had signed up for trupanion pet insurance after reading good reviews. Now my dog had a CCL rupture and needs surgery. They refused to cover ANY costs because they classified limping as a pre-existing illness. After my vet send them a lengthy letter (as seen in picture) they STILL denied coverage saying they do not cover any CCL injuries that occur within 18 MONTHS!!!!!! Absolute waste of time and money. My vet hates them too. Have cancelled my subscription.

I was in an accident. I was turning and collided with another vehicle traveling the other direction on a residential street. Apparently an attorney is involved now according to my insurance company, and it certainly has me scared. We have a job and house, but we are barely surviving, so playing legal games is going to break me. It also feels very unfair. I'm pretty sure, if anyone was injured in that car, it's because it appears the kids weren't buckled. It was a mom and kids on the way to school. I want to the back to help and saw a dazed kid rubbing his knees because they probably hit the console in front of him and he was crying. Not totally crazy, like im broken help it hurts crying, but like mildly hurt but mostly scared. I have kids. That explanation wont hold up in court but anecdotally I think he likely was fine based on what I saw and my own experience from the crash. I had mild bruises on the top of my legs, not visible, but just a sore feeling. But I was buckled. And I had a airbag in my face and a little dazed, but when I got out the math didn't work out in my head with how many people I was seeing and the number of seats available in that car. there was a baby seat but no baby. that leaves 4 legal seats in that car, but I'm pretty sure there were at least 5 people in that car. It was hard to figure it all out because of the shock of it and one or two of them walked off to a school or were taken by grandparents that showed up fairly quickly. I bet Its too late to go back and prove that, and I doubt there will be camera footage of it, but there is a slight chance because there is a medical business at that corner, its at the edge of residential and commercial. I dont know what to do. I really dont feel like anyone should have to pay for bodily injury other than her on this, but maybe that is just me being an asshole. It just doesnt feel right because the likelihood that they were playing clowncar with missing seatbelts is fairly high, and it was such low speeds. I didnt hit them in the door, it was front to front. Noone should have walked away from that with any real injuries if you were doing things like you were supposed to. I had minor bruises that lasted 2 to 3 days and were never visible. I'm about to be broken by some greedy person that just wants to cash in and I don't know if there really is anything I can do about it. Fight or not fighting both are too expensive for me to survive. I auto lose.

Hey guys, im a 24 year old male living in Ontario and just got hit with a complete blindside. I’ve been insured on multiple vehichles through different companies since 2018, no tickets, pullovers or anything. I just bought a new truck and found out when getting quotes that I have 2 at fault accidents on my record. The first was July of 2021, my 67 mustang hit a pothole and caused some minor damage to the fender. I called intact and asked some questions and they said the only way I would get any money towards repairs is if I put it through as an at fault-after hearing this I said no thanks and paid it myself. They never said anything about this going on my record, the whole point of me paying out of pocket was to avoid this. The second was on my truck in Feb 2024. I was in Colorado and my brother needed to move my truck out of the driveway, it was late at night and a neighbour was parked somewhere it was hard to see and he bumped into it. My truck was fine and I was away so I didn’t deal with any of it directly but my brother used his personal insurance to pay out the damages but this is on my record as at fault for me. Is there anything I can do to get this off the record? I’ve talked to so many insurance agents who just shrug and say they won’t insure me and that the circumstances don’t matter. I’ve had insurance since I was 17, paid over $25,000 since then and cost insurance companies $0 and they won’t insure me.

Has anyone else dealt with Progressive refusing to take responsibility for a rear-end domino effect accident with liability insurance, and then being told to fix your car first and wait for reimbursement while they wait for other vehicles to file claims

Hello, I have Aetna insurance and my daughter was prescribed to go for hypoallergenic formula. I spoke with agents, doctor office submitted required docs and they received a fax saying it’s covered. They directed me to Coram where I can order fomula. Coram and Aetna coordinated and determined I’m covered at 100% Now, in my Aetna app the claim is denied and my share is $6536. I have not received a bill from the provider(Coram). I’m panicking Please tell me if I owe the above amount?