I'm on my mom's blue cross blue shield medicaid IL insurance and for some reason I was kicked off last month and now it says I'll be back on next month. My mom isn't sure why that happened. When I tried to make an appointment yesterday my bcbs insurance ID wasn't working when it always has. But I NEED to go to a hospital some time soon. Will my medicaid ID work or are they together? If it doesn't work does that mean I'll have to pay out of pocket if I go before next month.

Back story: I have purchased health insurance via the Marketplace (I'm in OR) for the past 4 years, same company, same plan. Expensive but I use a LOT of health care. This year the increase was substantial - $990/mo just for me -gulp- I knew there was a 90-day grace period to pay for the marketplace plans, and I (out of need, not playing games) basically went as long as I could without paying because it's sooooo expensive to afford and I am currently in a "borrow from Peter to pay Paul" situation. I *thought* I paid in full by the end of March - I had a major surgery April 7 that had been prior-authorized, etc. Then when a friend went to pick up my post-op medications the pharmacist told her my plan had been cancelled. Finally managed to get through to the insurance company and lo and behold, I was exactly $117 short of what I needed to pay for the full three months. So not only did they drop me before my surgery, but are actually dropping me retroactively to 1/31/25 and sending me my money back. Despite much pleading on the phone to the insurance company (Pacific Source), they are telling me that because I purchased it on the marketplace they can't do anything at all to help me. Marketplace says they have no idea how they could help. a) it's only $117 short out of >$2000 of premiums and b) we're talking 10 days past the due date, not like 30+. Does ANYONE have any ideas here??? Not only do I need to have this VERY EXPENSIVE surgery covered (it's going to be well over $50k), but I will need follow up care for the surgery as well as all of my health care needs this year (ie I take a biologic that costs $8k/mo). I'm literally panicking here....and no idea where to go for help or what to do. Any ideas????

Help me understand this one. My wife was injured by my neighbor's dog, knocking her down and tearing her ACL (it wasn't aggressive, just large and friendly, freak accident.) Surgery was very expensive, went through my employer based insurance, no big deal. We start getting letters from Conduent, asking if someone else was responsible. Yes, neighbors dog and property. Gave them the insurance info, we all expected some subrogation of claim and I'd prepped my neighbors for that. Then I get another letter asking about what legal representation we retained in a suit against them. I called them and told them we haven't sued them. That we have a good relationship either our neighbors, it was a freak accident, and we aren't litigious. The woman sounded extremely skeptical and said something to the effect of "let's see how you feel about your neighbors in a few months. I'll check back in 6 months." It was the tone that really bothered me, sort of like "oh you just wait and see, you will!" Like something is coming down the pike that's really going to ruin my day and make me want to sue my neighbors. Can someone walk me through this one? Insurers work together in auto accidents without requiring litigation, I figured it would be the same thing here.

Hello all, I am here hoping to find some clarity as to what happened and if I did anything wrong. For context I am chronically ill and have ESRD (end stage renal disease), I am on dialysis 3 times a week, awaiting a kidney transplant. For the last 3 years I have had Medi-Cal and it was handled through California DPSS. This has been the case since I applied. Even when I went into kidney failure and went on dialysis, my medi-cal was still handled by DPSS. I even subsequently applied for Social Security Disability and still my Medi-cal was handled through DPSS. I was just hospitalized last month for a week, so I know that my insurance was definitely still active at that point. Well today, I called my PCP to make an appt and was told my insurance was no longer active. After HOURS of standing in line at the DPSS office, I find out that my medi-cal was transferred to Social Security at the end of March - Without giving me any notice: not even so much as a letter. I’m baffled… I now have to restart the process of picking out a medical group and all that stuff… how did this happen?? Why?? And did I do something wrong????

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!

My son has two insurance policies, one with me and one with his Dad. Both plans are with BCBS. Dental office called to tell me they can't run the claim because BCBS website is showing that he is inactive on Dads plan. Dad says plan should be fine. So no idea why the Dr office is seeing that. I asked if they could just run it under mine and they sad it won't work because Dads plan is inactive and the my plan won't pay until it's resolved. This doesn't make sense to me. Why would it not process with my plan just because Dad's plan is inactive? Wouldn't this be the same as my son only having one insurance plan now and run it without the secondary attached? Can someone break this down for me?

I am 21 and the oldest “dependent” on the insurance aside from my parents, we are under Molina/Medicaid. We are a family of five, with 2 minors in the home, our ages are: 50s, 50s, 12, 16, and 21(me). My parents file taxes together for a sole proprietor business that they own. Earlier in the year, we renewed are insurance and everything went smoothly and we opted to enroll in the system where Molina automatically enters your tax information for you that they receive from the IRS. My parents typically make ~80-90k combined, but after business expenses, taxes, and bills, they only bring home 30-40k a year. Basically, our family lives off of the 30-40k, NOT the bigger number. This hasn’t changed at all in the past few years, nor has it been an issue for our insurance. However, this year, we received a notice in the mail that none of us are eligible to stay on the insurance and that our insurance ran out on March 31, 2025. While I’m planning on calling Molina soon, I did see that it states that we made nearly 90k, when that isn’t the case. I think this may be an issue from the automation system not taking the accurate data for us. Does anyone else have similar issues or can explain my situation? Edit: my parents’ adjusted gross income is 30-40k for those who may be confused. I’m sorry if I didn’t clarify earlier Edit 2: I figured out the issue. I got off the phone and it turns out they never received our tax info, so we have to reapply. We’re planning on visiting our county insurance office and they just need some proof of income. Thank you for the comments!

FYI Thin Blue Line Benefits now has a company called Live Freely Health contacting members about claims. I got an email and then called them. TBL did not send out a message stating this would happen. The rep at Live Freely said they are just letting people know the claims will be processed. I personally call it "buying time" and would not give them any personal information.

I went in for my sterilization a few weeks ago and was SO excited to finally have it done. I have BCBS and my doctor's office said that insurance will cover the procedure 100%. But when I got to the hospital they said it would cost $10,000 because the hospital is not in network. Is the hospital correct on this or do I need to contest it because my insurance is ACA compliant? Can I contest it before the surgery so I'm not potentially stuck with a stupid huge bill?

Hi all, Hoping someone here can help me make sense of this or share advice on next steps. I recently had a BRCA genetic test done through Labcorp. Before the test, I received an estimate of $43.17 and got pre-authorization from Anthem. Everything looked good, so I went ahead. Now I’ve received an EOB from Anthem denying the claim. They say I’ve reached my “once per lifetime” limit for BRCA testing—and they’re expecting me to pay $3,000 out-of-pocket. I called Anthem, and they said the correct CPT codes were used and the denial is based solely on the lifetime limit. But I have never had BRCA testing before. It’s my first time. Anthem is now reviewing the case, but I’m trying to understand what might have gone wrong. My theory is that their system may have logged the pre-authorization itself as a completed test, and when the actual test was billed, it triggered the “second” test denial. Has anyone seen something like this happen? Thanks in advance!