I had a liver transplant in 2023 at Mayo in Arizona. I live in Oklahoma. I have BCBS of Arkansas through Walmart, where my wife works. Regular lab draws are required and I have a DLO (Quest) and few minutes away from my home. I checked DLO's website which stated they accepted my plan. I got my labs drawn many times over the course of 6-7 months before receiving bills from the lab for the full amount, insurance was paying nothing. After contacting insurance, they said the particular location was not in network. No idea why one would be out of network but other locations of the same company are. However, after conferring with both BCBS and DLO, I was told that BCBS of Arizona is being billed because that's where the ordering provider is from. No one seems to be very helpful on either end as far as getting anything resolved, and there's nearly 20K worth of labs being denied. Does this seem accurate from both the insurance perspective of billing another state's plan as well as why they would deny one location but not another of the same company? Any suggestions on what I should do or how to handle? Thanks!

Not really sure the best place to post this question. My health insurance fully covers labwork, which I confirmed with them prior to getting an MMR immunity test earlier this month. As in they couldn't find anything in my coverage about specific tests because I have 100% coverage. So day of my appointment imagine my surprise when the phlebotomist at my doctors office says I owe $40 to quest for the lab work(in addition to my $25 copay that I paid at the front desk). I thought it was weird, but figured I'd get a refund when I got my EOB. So I hand over my debit card, she enters the info on her computer, draws my blood, and then I go on my way. Today I get the EOB for that visit and it says, as expected, I shouldn't have paid anything for that visit. So I check both my bank accounts only to find there is no $40 charge for Quest anywhere. And then I remember the same thing happened in January with Labcorp. I went to a physical Labcorp location for bloodwork ordered by my dermatologist, they said I owed some amount upfront, I handed over my card, then when I got my EOB it said I owed nothing, but when I checked my bank statements there wasn't a charge from Labcorp at all. Nothing the day of, and nothing on subsequent days for a refund. What is happening? Are they somehow able to void the charge so that it completely disappears from my bank statements when it turns out my insurance fully covered it? In the future I'm going to be getting screenshots of any posted charges(and asking for a receipt), just to prove I'm not losing my mind. If they didn't charge my card on the day of my appointment, would they have charged it later upon learning I did owe something. Can they even legally charge my card at a later date, or would they have to send me a bill in that situation? With the Labcorp charge I thought maybe I'd misremembered paying because I've been getting lab work there for years and never even had to stop at the front desk. My insurance at work did change from UHC to BCBS this year, but our coverage stayed the same. But I know for sure I handed over my debit card to the phlebotomist at my doctors office and watched her enter the card information on her computer. Though I don't remember if I got a notification of the charge on my banking app. Do I still have to keep giving them my card if I know my insurance fully covers lab work but for some reason they are lying and saying I owe money upfront and then the charges are vanishing?

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.

26, California, $37,000. My health insurance provider denied me access to estradiol for the purpose of gender transition (MtF). I was prescribed this by my doctor and they called me to inform me that my insurance excludes anything under gender related health care according to a denial letter they got from the company. Blue Cross Blue Shield Kansas City provides the health care in Missouri because of the company being nationwide, although I am based in California. I have yet to receive a copy of the denial letter myself, but plan to get a copy of the one from my doctor's office if I don't receive one in the mail this following week from the company. According to the BCBSKS website they do cover gender transition and when I started this job I asked them if it was covered. My H.R. representative seemed confused about the denial and said she'd look into it as she'd never run into this before. She also that they supposedly cover gender related surgery at a certain percentage so something seems fishy. Is this a recent policy change? What are my options? I'm currently filing a complaint through my recently formed union at the company and will be using GoodRx to be able to afford it, but now I'm worried if I tried to receive anything else transition related and am frustrated it won't go towards a deductible. I don't have the letter of denial yet. Will I be able to appeal with information on the letter? Is this legal since I am a California resident or is it all purely through Missouri laws? Just looking for advice.

I have a question about prior authorization. I am trying to get one of the weight loss meds like wegovy, zepbound etc. I had several appts with my primary care Dr and she informed me she would try but that most likely insurance wouldn't cover it. The Dr office called me today to tell me about bloodwork, etc and informed me I should call my insurance provider and ask if it would be covered. I did that, with blue cross blue shield, and the lady on the phone was extremely helpful. She informed me ozempic and something else wouldn't be covered but wegovy and zepbound are and she would need prior authorization. She put me on hold to call my Dr, then when she got back on the line she said the Dr would not do prior authorization. She also informed me I should find a new Doc because your Dr is supposed to help you. My question is why would my Dr then deny it after asking me to call and see if it's covered and it was? I'm just confused. Thank you for any insight.

Hi all, I'm leaving my current job and I have another position that pays higher than where I'm at right now, but no employee health plan. I'm in CA. Right now I'm looking at marketplace plans for my spouse (33M) and I (31F). We don't use much when it comes to health care. A few random visits here and there, I take a few daily mental health meds but that's it. However, we do want to start a family in the next year so I'm trying to keep that in mind. I've always been on an employer PPO, so that's what I'm used to. My top options currently are Blue Shield of CA PPO, or Kaiser Gold HMO. From what I've seen blue shield is one of the few companies that will offer PPO on the marketplace. I've looked at some of the cheaper plans through multiple companies but since most of them have coinsurance, I worry I could rack up quite a bit if I were to get pregnant/deliver. We earn too much to qualify for financial help/ACA plans as well. Here's my question - how much does Kaiser's HMO plans differ from their PPO? Is it really a big difference since it's all in one system? I know there are issues with Kaiser and it seems people either love it or hate it. But it seems like their HMO plan is cheaper with better coverage (particularly for maternity) than a similar PPO through blue shield. Anything I'm missing here? Any advise or prior experiences would be helpful.

Not sure if I tagged this right, but basically I was covered by a MA ConnectorCare (CC) plan until January 31st of this year, and now I am covered by my employer's BCBS plan as of February 1st. I received my first Gardasil shot on January 31st, the last day my CC plan was active, but my doctor billed BCBS (I added it for my second shot on Feb 28th) and now I'm getting a $700 bill for the office visit and the shot because that coverage wasn't active yet. Is it possible to tell their billing department they need to retroactively bill the CC plan as that's what I was covered by on the date of service? I actually work at the office where I got my shots, and I have a pretty good idea of what my plan will cover with or without a copay, and this is not correct.

I have BCBS Horizon of NJ PPO. It’s my dad’s plan thru his work at a large sales company that has no religious affiliation. He’s worked there only a few years definitely after 2019. His job is in NC, I’m a MD resident. Currently battling insurance for a bilateral salpingectomy which is a form of permanent contraceptive and falls under preventive care and the ACA. My plan offers preventive care 100% covered in network. My insurance is telling me it’s covered at 80% after my deductible is met ($1200). One rep even told me my plan must not be aca compliant then. I looked into that and BCBS NJ horizon has not offered a non aca compliant plan since 2013. This rep is flat out lying, right? Well she gets a supervisor involved and he can’t confidently say whether my plan is aca compliant or not. It covers birth control 100% (I currently am on a 100% covered by them birth control). I think they may be looking it up as an outpatient surgery and not as preventative care. How do I tell them to look at it from preventative care and not outpatient surgery? Is it even possible for my plan to not be aca compliant? I’m currently in communication with an hr person from my dad’s company. She hasn’t gotten back to me yet and I really want to sleep tonight. My surgery is March 27th and I really can’t afford for it to not be 100% covered. Please help 🙏 💜

Last June, I went to urgent care because I was leaving for a vacation out of the country the next day and started feeling sick. I couldn’t get into my primary doctor before leaving and just wanted a steroid shot or antibiotics to avoid being miserable during my trip. I went to an urgent care near my job, knowing it would be more expensive than my normal copay. I usually pay a $25 copay at my primary doctor, but urgent care costs $50. When I arrived and checked in, the receptionist asked for my insurance cards, which I provided. I’m double insured, as I’m still on my parents' insurance, but I use my insurance as primary and my parents’ as secondary. I’ve never had any issues with this setup and typically don’t have medical bills because of it. The receptionist asked if another name (I assumed it was another patient) was on my insurance policy. I confirmed that I’m the only one on my insurance policy and explained that my parents’ insurance is secondary. Both of my insurances are Blue Cross Blue Shield, though I’m not sure if that matters. The receptionist seemed confused but said, "Okay, it’s going to be expensive, but your copay is $50." I agreed, since I felt awful, and paid with my HSA card. I was only tested for strep and flu (both negative) and was diagnosed with a sinus infection, for which I received a steroid shot. Fast forward to my trip abroad, where I had to visit a doctor at my resort, pay $500, and was diagnosed with bronchitis and the flu. Last week, I received a call from a collections service saying I owed $244 for my urgent care visit. I asked how that could be possible since I was double insured, but they couldn’t answer. I called the urgent care, and they directed me to their billing number. After waiting for an hour and a half on hold, I was told I owed the amount. I asked again why, given my double insurance, and they said they only had my parents' insurance on file, and that their insurance had denied the claim. I asked why it was denied, explaining that my primary insurance at the time was through my job and my parents’ was secondary. They asked to put me on hold to investigate, but the call was dropped. I called back and was on hold for 45 minutes. I then received a call from an unfamiliar number, and the voicemail said the call had been disconnected and to call back to resolve the issue. I called back and reached a different urgent care I’d never heard of. I asked for the person who left the voicemail, and they said they didn’t know anyone by that name. I explained the situation, and the person said they had been receiving similar calls from others and advised me to be careful with the information I shared, as they were unsure if their office number had been linked with spam. I then went to the original urgent care, which is 10 minutes from my job, and asked for clarification. They explained that my primary insurance was never added to my account, but when I went in for clarification, they added it to my file. Since their billing has been outsourced to a third-party company, they can no longer access statements or accept payments. They directed me to that number but said they would speak to their manager and call me back since they’ve received multiple complaints since moving to this company. I’m unsure what to do now, as the urgent care never billed my insurance correctly, and the bill has now gone to collections. Any advice on how to proceed?

TL;DR: Employer canceled insurance benefits without notice while on FMLA due to nonpayment, despite efforts to pay. Hi, there. I’m currently on a medical leave of absence from work, and have been experiencing some difficulties with my FMLA/insurance benefits. I’m new to this, so any input would be appreciated! My leave began the last week of December and I’m set to return on 3/24, the last day of my FMLA protection. Since my leave started, my main priority was getting my insurance premiums taken care of so as not to lose my benefits, especially since I’ve racked up substantial medical bills over the course of my leave. I reached out to my benefits department, and was instructed to reach out to a third party (WEX) to make payment, which I did. WEX informed me that there was no balance due reflected on their end, and to reach back out to benefits. This back and forth has gone on for months now. At one point, they told me to reach out to BCBS to make payment, and BCBS acted like they had no idea why I was directed to them in the first place. I’m over 10 weeks into my leave, and have not received a single correspondence about my health insurance until today. Not a phone call, email, or letter. I did, however, receive a bill from WEX for my vision and dental coverage, but nothing whatsoever in regard to my medical coverage. Once I received the dental/vision bill, I called same day to make payment and was told, again, that there was nothing in the system to apply payment towards. Reached out to my benefits department again, and they said they could see the unpaid premium for my dental/vision. Called WEX again, and after escalating and speaking with a supervisor, was told that the reason why I was unable to pay my dental/vision is because the plans had been cancelled due to nonpayment. When I reiterated several times that I’ve been trying to pay for quite some time by that point, I was told that if I mailed the payment ASAP, there is a “strong possibility” they might reinstate the plans. I mailed the check the following morning, and am hoping it works out in my favor. What I’m most concerned about, though, is my health insurance. I spoke to someone in our benefits department in February, and was told that because I’d exhausted my PTO the first half of January, my insurance premium would have been deducted from one of those paychecks. According to the representative with whom I spoke, “January was covered.” I told him I’d received bills for my dental/vision coverage, but still hadn’t received anything for my health insurance. He told me to just wait a little bit longer for it to show up in the mail. Over 10 weeks later of non stop calling and trying to stay on top of things, and I still haven’t gotten anything. I expressed that due to the nature of my leave, I really needed to keep my insurance coverage, and was terrified the third party was going to cancel my policy for nonpayment. He reassured me that the only one able to cancel my insurance would be my employer, and they would “of course” provide me with ample notice prior to that. When I told him it didn’t make sense that I’d receive bills for my dental/vision but not my health insurance, he told me to not worry because my health insurance will remain as is regardless. That my account would just go in a rears and my employer would deduct the unpaid premiums accrued during my leave from my future paychecks once I’m back to work. A supervisor from benefits called me today (10 weeks after my initial call), letting me know that the reason why WEX didn’t have my balance due in their system was because my health insurance was cancelled on 1/28. When I told her that I’ve been calling for help for months now, and continue to get the runaround, she just kept saying it was my responsibility to cover my premiums while on FMLA. When I told her that benefits told me no one would cancel my health insurance without notification, she disregarded it. Same when I mentioned the rep telling me that my account would just go in a rears and they’d deduct the premiums from future paychecks. She told me that I owed for January, February, and March, and that there is a 10-day grace period where I can get caught back up to “hopefully” have my coverage reinstated, but couldn’t be for certain. I checked my last paycheck from January, and the deductions are reflected on it. I’m just very confused because she was adamant I owed for January still too. I just don’t see how they can cancel my insurance: 1. Without notice, and 2. After I’ve made an effort to get it paid since the very beginning of my leave. Someone had mentioned this being problematic because of potential FMLA violations, but I’ve never gone through this before and I’m honestly unsure of the process, and obviously don’t feel comfortable reaching out to my employer given the misinformation I’ve received thus far. Our market is experiencing mass layoffs right now, and I was hesitant to go on leave in the first place because of it. I don’t know if it’s worth mentioning or not, but the day before my leave was set to begin, thought to call Alight just to make sure I was not going to be reprimanded for not coming in. The representative informed me that my LOA request had been cancelled. This gave me pause, as the only ones who knew about the LOA request was my immediate supervisor and Alight. I’d have been no call, no show and subsequently terminated had I not thought to call beforehand. I’ve just been worried so much about all of this, and honestly regret taking the medical leave even though it was necessary. I’ve spent more time going back and forth with my employer than I have with my physicians and it’s been hell. Does anyone have any input regarding this situation? Is this just an HR issue and nothing more or should I consider seeking legal counsel? Thanks so much ❤️