I’m looking for a new dentist and almost every dentist I calls either is out of network for Anthem or isn’t accepting new patients. I have an HSA account so I have the funds to cover any fees that I might need to pay currently but I’m unsure moving forward if I should just drop my dental insurance and just move to a dentist that I like? I need some crown work currently so I could get that work done before dropping insurance but otherwise I just need regular cleanings and an occasional filling here and there.

This might be a doozy, but here I go. Thank you advance. I decided to get my own insurance (so my insurance wouldn’t be tied to my job in the event of job loss). I searched in marketplace. I entered my criteria to find a plan that covers my PCP, my daughter’s pediatrician, and my medications. Marketplace found me a plan that covers it all and I enrolled in December to start in January. Today I had an appointment with my PCP. As I checked in, I handed them my insurance card, and they let me know he was not in network. Which is WEIRD considering I made sure I picked a plan that he was in. I left and called my insurance. They told me he was in network. They confirmed his address and phone number - it was incorrect. It was his old hospital from over two years ago. I gave them the new information. She left me on hold for a while and came back and apologized, saying he was NOT in network with my current plan. She said since I got my insurance through marketplace, I need to contact them. So she transferred me to marketplace. I’m now on the phone with marketplace. I speak to the representative (who was clearly in a bad mood) and he had no idea what was going on so I had to explain the situation again. He put me on hold and when he comes back, he says that he’s not sure why I’m talking to them when I should be on the phone with BCBS. I told him that I got insurance through marketplace, and I only picked my plan because it was in network with my doctor, which was clearly incorrect! He said that I was not entitled to 100% accurate information on marketplace and it was my duty to double check to make sure my doctor was in network. Which, according to BCBS, he WAS! At his OLD PRACTICE. From two years ago. And he is not now. I asked about changing my plan so I can actually see my physician and he said open enrollment was over and I would have to qualify for special enrollment which we could not do today. He told me to call BCBS again. I call BCBS again and the new CSR I spoke to was even worse. She basically told me to call marketplace. I told her what they told me and she said that was incorrect information and it was up to them. I am on the verge of tears right now. I’m playing this back and forth and I don’t know what to do. Do I make a complaint with marketplace? How do I go about it? None of this is my fault but they’re either blaming each other or blaming me. I just want to see my doctor, man. TLDR: got insurance, was told he was in network, turns out he isn’t in network because of incorrect address on file, and now I’m trapped in a limbo with BCBS and Marketplace and no one is being helpful. ETA - unsure if this is relevant in this situation, but I am 32, in Oklahoma, and gross income is over 100k. Maybe 140.

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.

Anyone familiar with this? Or the MassHealth system in general? I am behind befuddled here. Received notices over the weekend that my children’s MassHealth Standard was downgraded to MassHealth Family Assistance. Mine stayed the same. Dads was terminated. We are not married. Dad goes through the VA and does not need health insurance. He is 100% disabled through the VA but still employable ‘outside his field’. The kids have been on MassHealth for at least 7 years now. Dad got a job last year, we reported the income, nothing changed except for his no longer needing health insurance as he didn’t realize the VA was sufficient (we are required to carry health insurance in Massachusetts). I received these letters this weekend and cannot get a live person on the phone. I don’t know if I need to find the kids a new health plan or not. The letter is not clear, at all, as to what my next steps are and coverage ‘ends’ from MassHealth Standard on this coming Saturday. One of my children was born with several medical conditions and we pretty much live at the doctor/specialist. If anyone had any guidance or advice I’d gladly take it!

I’m in shambles. A surgery out of network I was approved actually late last year is somehow now denied in network now? And the record of approval is nowhere to be found?? Literally saw it three weeks ago. I want to make sure this appeal hits the ball out of the park with all necessary info but it’s such an uphill mountain and I was so happy for a month and a half excitedly waiting for my surgery next month. Please help.

Hi all, I recently moved, got a new gastroenterologist, and switched to Blue Cross Blue Shield insurance. I specifically went to the new doctor to get a prescription for Viberzi for my IBS. I've been on this medication for four years and knew the new insurance would require prior authorization. Long story short, my prior authorization was denied because the insurance company said my medical history wasn’t documented. I was confused since I had already submitted my past medical records to the new doctor. When I called the office to check, they told me they *can’t* include previous medical records because they were from before I became a patient there. They said they are going to submit it again and it will go to a peer-to-peer next. And I asked if the doctor will submit my medical history then. And they told me "He doesn't need to send your medical history. He's a physician." I’m really frustrated and not sure what to do next besides hoping the peer-to-peer thing works. Has anyone dealt with something similar? Can a doctor really not use past medical records for prior authorization? Any advice?

Hello all, I am desperately trying to find health insurance coverage for my pregnant wife. She graduated college in December and went from a CNA to an RN with a start date of March 10th. Her HR told her that she would have a new open enrollment and that she could let her coverage lapse and gain new coverage when she started as an RN. This was before we knew she was pregnant and we were going abroad for a while and so we did not renew the insurance for 2025 thinking that we would just start it again in March. We thought that because she was still employed, there wouldn't be a waiting period for when she got her coverage but we found out today that she won't be covered until June. She is due in August so we definitely need tests done before June. We got denied on Pennie for a qualifying event (PA marketplace), short-term policies don't cover pregnancy, and I am under my mom's coverage so I don't have a policy she could come to. Please, if anyone has any insight into this, PLEASE help!

I need to find an insurance plan asap as only recently have I been told I can’t get Medicaid here in Florida , I am from NC and moved down to Florida last year to live with my boyfriend and his family , the only plans I can find have horrible deductibles and 90 dollar specialist visits!!! I am sadly a rare case and need to see multiple specialists multiple times a week normally and can’t pay 90 dollars a visit along with 400 dollars a month on insurance as I haven’t worked in over a year and my boyfriend cares for me financially. I’ve heard of blue select but that is definitely not an option for me as I stated I will need to see specialist multiple times a week and the deductible is so small , I am 21 years old please help! I’ve always been on my parents insurance but clearly it’s NC Medicaid and not Florida so I can’t use it out of nc

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 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?