I was charged $2500 for an ultrasound required for my high risk pregnancy. My insurance provider (BCBS of IL) states that that my portion owed is $0, due to "**Discounts Applied -** Your BCBSIL plan has negotiated cost savings for you with your provider. You may still need to pay part of the bill. Check Details of Services for details of what you may owe." Under details of services, everything states I am responsible for $0. There is no copy of the EOB for this charge - every time I look it says it is "not available at this time." In the meantime I have received a bill from the in-network hospital, stating I am responsible for the full $2500 because my insurance did not cover it. I actually have 3 similar bills just like this, but only including one for simplicity of questions asked. I plan to call my BCBSIL tomorrow, but what are some questions I should ask here? Should I be verifying my cost owed is $0 and then having them contact the hospital directly to refute the bill? Or do I need to contact the hospital directly? Or is there a chance I am actually responsible here? I haven't seen this "discounts applied" verbiage before, so I am a little confused.

UPDATE: I called this morning and apparently the post authorization did get approved without my knowing and without updating in my online portal. It's still showing online that I owe the full amount but the employee I spoke with said to ignore those charges and wait for a bill in the corrected amount of $333.87 which is much more palatable. Major thank you for everyone's input!! It was late and I was getting very anxious about it, I seriously appreciate everyone's comments. Hopefully there won't be any more mishaps and I know better moving forward to make sure preauth gets sent. Recently I had a colonoscopy at the suggestion/request of a gastroenterologist for issues I've been having. This was my first time having any kind of outpatient procedure and my first time dealing with marketplace health insurance (United Healthcare) on my own. I did not know that prior authorization was a requirement for this procedure. Prior to scheduling the procedure I spoke with UHC about coverage and was told I'd only be charged the copay because it was in network. After the procedure I found out the medical office and hospital failed to request authorization and did the procedure anyway, now I'm being charged $5,000+ for the colonoscopy because of it. I didn't know I needed authorization and moreover it was the medical facility's responsibility to get that, and NOT perform the procedure unless it was granted. Am I mistaken? Has this happened to anyone else? What are my options? I've already called the medical facility to submit a post-authorization appeal but it seems to be denied as well. I'm at a loss and feel entirely screwed over, would love some advice!

In 2024, I received a call from rep at Innovative Partners LP (my first mistake) and the rep was so convincing that I gave my cc to receive healthcare benefits. I was sent an insurance card. Innovative Partners LP partnered with Marpai Health to handle invoices from medical visits. I had 3 medical office visits (1-primary, 2-dermatology and 3-LabCorp for routine blood panel). Of the 3 visits, only dermatology visit was paid. LabCorp has sent my medical visit invoice to collections! I have been doing everything I can to get Marpai Health and Innovative Partners LP to pay their portion of this invoice. I don't know what else to do. I reported both organizations to Better Business Bureau with NO results. I have written to both organizations and nothing. What else can I do to get this LabCorp bill paid by the healthcare coverage? I know I have to pay my portion and I will .... AFTER Innovative & Marpai pay their portion. I even sent my state representatives a letter about this issue and nothing. Since August 2024, Marpai canceled their relationship with Innovative but while I was covered, there was an ongoing relationship. That they terminated their contract with Innovative is not my problem. While I was covered (from Feb to Aug 2024), they were in contractual agreement. I don't want this invoice in collections, I don't want this hanging over me. I want Innovative & Marpai to honor their paid plan benefits / coverage to me. What suggestions do you have that worked for you? Thank you!

My husband lost his job a month after I gave birth and is on unemployment now. I applied for Medicaid and now my son and I are on it. However, we both got a card for some Amerigroup plan which is through Medicaid? My son's pediatrician only takes Medicaid and not this plan but I'm confused. Is this not still Medicaid? And if not, why would we get put on this plan from Medicaid when we never asked to be put on it? Can I reject this and just have us on plain ol Medicaid? Who am I supposed to call to get this fixed? Age: 32, Son is 5 months. State: GA. Estimated income: $30,000 from unemployment. 3 person household I don't understand how this works. Can someone explain it to me like I'm 5 lol.

Age: 40+ State: California Income: 0 (unemployed) tl;dr: I had some election snafu made by the COBRA management company where they just re-enrolled me in PPO which was $900/mo. I opted to go for a cheaper Kaiser option for $300/mo. Somehow I see when they fixed it, my PPO still shows covered and I have nothing regarding being enrolled in Kaiser... what should i do? Longer: So in my COBRA payment portal it shows I'm paying for Kaiser (cheaper) option and I have been paying for this coverage since the start of 2025. I haven't had to use it and I am just now needing to refill a prescription. Also, my old company switched up their insurance at the start of 2025, so even if I stayed on my PPO it would have changed providers. Anyways now that I need to refill a prescription I started looking through the docs I received and realized I never got any sort of Kaiser welcome packet but did receive a PPO insurance card, so I figured I would register on their site to see if it would let me. Surprisingly it did and the PPO shows I am covered. Now, normally I am one to do the right thing, but insurance is inherently evil... so part of me wants to go fill my RX using this PPO coverage and see what happens. Is this a bad idea? I definitely cant afford for them to go back and charge me an extra $600/mo. What do you all think?

My question in the title does not in anyway mean as an attack, simply my genuine curiosity based on my personal experience. My parents recently migrated to California so we went to a certified enrollment counselor in NorCal. For some reason this counselor keeps pushing BenefitsCal and also to sign up for her clinic's health care plan. I am already a Kaiser member myself, so I wished to sign my parents up for Kaiser as well. But she kept pushing back, I assume because she benefited if we signed up for her orgs plan. The whole thing made me very uncomfortable. Wondering if anyone has experiencedthe same?

I picked up a few prescriptions in January for a Tier 2/$30 copays. This was a transition fill because my employer switched pharmacy benefits manager (PBM) and the medications were not on the new formulary. They said the lower cost was a grace period and standard of care while appealing for an Exception For Coverage. A few weeks later my Exception For Coverage for the medications were approved so I paid Tier 3/30% coinsurance on the next fills in February. The Exception For Coverage was backdated to January 1st, 2025. Then, the following month it looks like the PBM reprocessed the January fills as a Tier 3/30% coinsurance and the additional cost was applied to my out-of-pocket maximum accumulator through my health insurance. I'm not sure what is going on here? I called the PBM and was advised that they will not recoup cost from me and they will not ask the pharmacy to reprocess the claim. The OOP max was never mentions previously, but the representative confirmed that my current out-of-pocket maximum (with the added amount) was accurate as well. Is this common practice for PBMs? Or, could it have been a system error? Has anyone else had something like this happen to them? I am so confused about this because I have not been billed for the additional increase in coinsurance from the PBM, but it feels like fraud since I know the numbers do not add up.

Hi everyone, the title is basically it. I have a marketplace plan starting last year. I signed up for autopay, or so I thought. Turns out not a cent came out after the first payment. There was zero notice. They said they snail mailed me something but I'm in the process of moving and my mail comes to my parents house. Not to mention if I saw something I would have assumed it was a monthly statement and tossed it. They had my email, my phone number, i received multiple emails but not a word about my account. I have a medication I order about once a month that costs around 2-3k without insurance and I'm racking my brain to figure out if it shipped after january. TLDR - bcbs told me that my account is just termed. I cant reactivate and need to contact the marketplace. Does anyone have any advice?

This is a weird problem to have. My therapist is not in-network (I have United Healthcare/UMR) so I pay her and submit the bill to UMR for reimbursement. For about a year, my insurance has usually said she is in-network, and reimburses me for about 50% of the cost (100% of their "adjusted cost" which is half of what I actually pay her). I mentioned it to her but she said she has never been in-network, which I believe - it would be pretty dangerous for her to try and take payment from both me and the insurance company. So I figured it's fine, if my insurance says she's in-network when it comes to reimbursements then I'll believe them. The reimbursements this year are now 95% of the actual cost (so they're paying me back more now). And I'm really starting to wonder, is it my responsibility to say something to the insurance company about this? Is there a chance that they ask for some of this money back later? Thanks for your advice