Question about marketplace insurance vs. private. My husband and I are partners in our own business so we got on a family marketplace plan this year after much due diligence on my part to ensure our providers were in network. We found out the hard way that just because some hospitals in a health network are covered, doesn't mean all are covered. This was upsetting to us because having both worked for the large health networks around us, we know where you go for procedures matters. I did a search of all marketplace plans for the 2 hospitals we prefer and NONE are in network. I got an email recently from an insurance broker who quoted me a price for Anthem BCBS that is a few hundred dollars cheaper a month than our marketplace plan including subsidies. There is a small deductible that I don't have with the marketplace plan and some limits on how often we can utilize a service but this would be OK with me if we could go to the hospitals we prefer. I'm also worried the healthcare subsidies will go away next year so finding a cheaper plan puts me a bit at ease. Is there anything I need to be super aware of with private plans? I'm curious how a private plan could be cheaper than a marketplace plan which is what is making me wonder if it's too good to be true. Thanks for any insight you can give!

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?

Hey y'all This is my first time posting here. I am going to be starting a job here soon where I need to get my pre exposure rabies vaccine prior to starting. The issue I am having is my health insurance (Anthem blue cross blue shield) doesn't cover it and it is gonna put me down like $800 with finical compensation from my employer. I live in Kentucky. I was wondering if anyone has any advice or ideas of ways I could try to get that price down. I'm not sure of theirs any good answers but figured I would ask. Thank you all.

Anthem blue cross blue shield is trying to charge my 20% coinsurance from the bill total rather than the allowed amount. Is this correct?

I was on my domestic partners health insurance for a couple of months before they left their job. We had all the papers signed legally in front of a notary and I was officially listed on their insurance. However, they left their job and I am trying to get insurance again through Anthem Blue Cross Blue Shield by proving that I was on my partners insurance. Sadly it has been nothing but a back-and-forth struggle, sending paperwork, and asking for their phone number only to be ignored. I have given then my full name, my partners full name, my partners termination information, and I have even used the insurance at a local urgent care recently (plus printed out the document showcasing my full name listed as a domestic partner on their insurance). After proving I am who I am, they keep asking for more information and this time asked for my terimination date from my job to prove I was on the insurance. But I didn't leave my job. My partner did, which I have explained. They also asked for the loss of coverage date, but I have sent previous emails with that said date. Long story short: I am trying to prove I was a domestic partner on my partners insurance, only to be asked again and again for more paperwork (of ones specifically I have already provided). Has anyone else faced this issue? Is there any way I can go about this in a more efficient way or anyone I can contact? Thank you! I really appreciate the help.

I’m having trouble finding a provider I’ve applied to 30 different providers through the Anthem website (I was referred to this website through Med-iCal), when re-directed to many providers websites that can take supposedly take my insurance they usually provide a dropdown of insurances they take. I applied for California Med-iCal and am curious as how to describe my insurance? Is it an Anthem? Is it Anthem Blue Cross Blue Shield, is it a LA Care card, is it a Med-iCal card? I’d also like to add that there’s every combo version of what I just mentioned and not direct way for me to know which one? I’m am genuinely losing my mind, anyone with a similar insurance and help would be great. Yes I’ve called the numbers provided on the back. No help.

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.