I have United Health Care’s high deductible plan, which I chose vs the lower deductible when I started my job 3 months ago for the HSA and because I have no medical conditions and rarely see a doctor. I’ve developed neurological issues the last month that have required a doctor visit, MRI, and now a follow up and likely more testing with a specialist. The doctor visit was $177 after a discount and MRI was $621 after discount. Does insurance even with that plan really not pay anything more? My old plan through my old job was high deductible with HSA, but bills were still only $70. At the rate I’m going, my old and new HSAs will be drained well before I hit my deductible, so I won’t have money to pay the bills. I guess the short answer is the doctor offices won’t get paid until I have the money, but is there anything more I can do? I can’t imagine how expensive seeing a neurologist will be plus whatever tests they want even if in Network.

I had an MRI arthrogram ( contrast for hip labrum and joint) and it was coded 27093, 77002, and 73722. And then the pharmacy drugs. My insurance is trying to bill this a surgery as they say code 27093 is under the surgical code section in the CPT guidelines. Normally I would have 100 percent coverage for any outpatient clinic ( non hospital) MRIs. My insurance says even though this was not done at a surgical centre or with a surgeon ( only a radiologist), they can charge me as if it was a surgery and therefore also charge the radiologist as surgeon fees. Does this make any sense at all? That way they say I have to pay 20 percent of the whole package of MRI ( 73722), Radiology diagnostic ( 77002) , and the local anesthetic used by the radiologist prior to the iodine injection ( 27093). So even though my work insurance normally would cover radiology diagnostic and all imaging at 100 percent, they say because of 27093, this is now a full blown surgery and only covered at 80/20 rather than 100 percent. Is this true? I will post in CPt code section.

Hello. I’m looking for options or ideas to fight the denial. I’ll start by saying I’m not medical insurance savvy whatsoever, I struggle to fully understand the what’s and whatnots. Her insurance is Christis Health Plan. My mother (45) battled stage 3 cancer last year up until two months ago when we finally got the good news she’s in remission. As she’s come off an aggressive treatment plan, she has started to lose function of her legs. Her PCP has ordered an MRI to attempt to diagnose but the insurance has denied it. Currently she’s on a medication to ease the numbness/ loss of control but over the last few weeks it has gotten to the point she cant make it up the four stairs without help and falls on uneven ground. I’m not sure how much else info is relevant but I’ll do my best to answer any questions. She’s calling both her doctor and insurance in the morning for further information. What specifically should she be asking? Is there anything we can do to help get this approved? Any help is so appreciated as a $1400 MRI cash pay seems daunting, much less whatever it may cost to get her back in walking order.

Hi All, I'm hoping you can help me review my options and come up with a plan for a recent unexpected (and I believe inaccurate) medical bill. I get annual cleanings and other routine dental care (e.g. 1 set of x-rays a year) for free under my dental plan. I have just recently gotten off of my parent's insurance and onto my own plan so I made sure to double and triple check both on my insurance provider (Cigna)'s website and on Zocdoc that I was booking an in-network appointment. At my appointment, however, I was seen by a different dentist than the one I booked with who ended up being an out-of-network dentist. I was surprised by a $400 bill from Cigna, which should have been $0, several weeks later. A fruitless chat with a Cigna rep led to them reprocessing my claim, even though I knew it wouldn't do any good since the information submitted by the dental office showed that I was seen by the out-of-network dentist. A week ago the claim was processed and my bill went up to nearly $1000 because they say the facility is out of network. It is not, and I have a screenshot from Cigna's website showing it isn't. Anyway, I'm feeling a bit lost about how to proceed. I know about the No Surprises act but am not totally sure how I would go about using it to my advantage here -- I do have the original emails showing that I booked my appointment with a different provider than the one who saw me, but am not sure how I can communicate this to the right people. Any advice about next steps would be very much appreciated! TIA for helping me figure out how to move through this. EDIT: In my 20s, live in NY State, insured through employer.

My husband and I signed up for BCBS of Illinois PPO+ plan through his work this year. I started seeing a physiatrist who was in network. When my claim was submitted, they only approved a discount from $360 to $219 leaving me having to pay $219 out of pocket. I previously had United Healthcare from my last company and with that insurance my physiatry appointments were only $30. I have read through our policy agreement but have to admit, I have no idea what I am reading. Can someone help explain what is different between my currently BCBS plan that only approves a discount vs other plans who only make you pay the co-pay? Thank you!

My wife recently had sinus surgery, and we paid a $3,000+ hospital bill before the surgery as they said she couldn’t have the procedure without paying it. That covered the rest of her OOP max. Cigna still hasn’t processed the claim two months later, and meanwhile other bills and late fees are stacking up because her OOP max isn’t shown as being met. We contacted Cigna and they said it finally processed last week (not reflected on their website) and that we need to allow 21 days for it to go through. How do we handle this with other providers calling and threatening additional late fees? My wife wants to pay but I think we should wait for the claim to go through.

My Dr wants to enroll me in a weight loss support group program. I have a high deductible plan with UHC so I will essentially be paying out of pocket until I meet my annual deductible. Dr's office asked me to call my insurance to check if it's covered, and they told me the billing codes. UHC said it's covered, but the cost ranges from $30-250 (per 20 minute session) depending on what the provider charges. They will pay 90% after I meet my deductible. They say that they don't know how much a particular provider will charge. I asked my Dr what they would charge, and they said the price is set by the insurance company. Who is lying?

Hi, I'm trying to reduce the chances that the insurance company not counting the copay card payments toward my deductible or out-of-pocket maximum. Does using their specialty pharmacy make that more likely? In other words, are they more likely to side with the insurance company? I'm with Anthem through the exchange, and their specialty pharmacy is Carelon. I read that accumulator programs have been banned in Nevada starting in 2025, but even the representative I spoke with at Carelon said that's not the case. thanks Matt

2024 I met my deductible for the first time so I decided to see a sleep doctor. Found the doctor through my insurance portal as in network. Went to my visit, no payment as my insurance is accepted. A few months later I was billed as out of network. I call the doctors billing office and they assure me they are in network, they will resubmit to insurance. I get another bill, doctors billing department reassures me that they are in network, resubmits. Now in 2025 insurance and doctors office confirm that the doctor only became in network for my particular plan 10/1/2024 and my two appointments were in September 2024. Very suspicious. Is there anything I can do to get out of paying? Everybody was on the same page so I am not sure what happened? I suspect the doctor forgot to renew with my plan and so it went into effect the following month of my visit?

I have a health plan with Aetna, and for specialist office visits, the copay is $65. For outpatient diagnostic testing, there is no charge, no copay, and no deductible applied. I went to my specialist's office for a blood test with a nurse, without seeing the doctor. A few weeks later, I received a bill from the doctor's office showing that I owe $65. I called my doctor's office, and the finance department said they billed using CPT code 36415, which is correct. Then I called Aetna, and a representative said, "Because the lab is an in-house lab at my specialist's office, if I go to a doctor's office for outpatient diagnostic testing, the $65 copay applies since I received a service from the provider." Is this correct? I had blood work done at other specialists' offices last year without seeing the doctor, and I wasn't charged the $65 copay. Did Aetna change their terms this year? Has anyone had a similar experience? Is it normal for Aetna to categorize diagnostic testing done in a specialist's office as a doctor's visit?