Hey everyone, I'm currently living in CA and am on an Anthem Select HMO through my employer - my entire family (wife, daughter, me) are covered under this plan. My wife is currently pregnant with #2 due in September. However, my family will be moving to Pennsylvania in a couple months, and I will likely be staying with my same employer/plan (this is still to be confirmed but seems like it'll be the case). However, the Anthem Select HMO does not have coverage in the area we will be moving to, but the company also offers PPO options that do have coverage in the new area. Will moving across the country, at which point my coverage would essentially be lost, count as a qualifying life event and allow us to switch to the PPO coverage? I tried to reach out to the insurance company, but they said they can't make that determination. Is it a state requirement that determines it? If so, would it be CA state or PA state that would take precedence? I'm waiting to explore further with my company until it's for sure that I'll be staying with this employer as we're kind of keeping it on the hush-hush until it's official. Curious on your guys thoughts.

I was laid off effective 3/31. (Thanks, Trump and Musk.) I filled out the application with PENNIE on 3/31. Got approved and told I have 60 days to select a plan. I called PA/PENNIE then. I didn't have my COBRA info yet so couldn't make an informed decision. I just logged back on to PENNIE and while it still says "you have 52 days to choose a plan," the effective date is coming up as May 1st, not retro to April 1st (like how COBRA works). I've called and the rep is not well-informed. The last time I called, another rep said "yes you can choose later and it goes retroactive."

So I've been going to a psychiatrist practitioner for more than 2 years now. I've paid a $25 copay each visit. I've never had to pay a deductible, it's always been the same practitioner as well. Out of the blue in January I get sent a bill that is many many times the cost of my copay, with the bill stating that it's my deductible. I called my clinic and they tell me nothing's changed, that the insurance was sending back that it was out of network and that they'll resubmit. I called the insurance and they let me know that in the past they were filing claims as a family practitioner, but now they're filing as psychiatry/specialist which is subject to my deductible. They mentioned that I could file a dispute, but that everything did look accurate and they're not sure how or why it was charged as general practice before. When I called my clinic back they told me they'd been bought out and that the practice is a specialist clinic and told me basically they don't care how it was charged before. I am very frustrated. I went ahead and cancelled my next appointment and am looking for options to continue on my medicine. I'm hoping my old family doctor might be able to pick up the prescription. Not sure what else I can do. I would not have went in for my visit had I known it was going to cost me multiple months of rent. And all just so she can ask me 3 minutes of questions and write the same prescription I've gotten for the past year. Is there anything I can do to get out of paying this bill? I was not told before hand that anything was changing. I know it's more complex than this but I can't help but feel like I'm being scammed out of my money. Also does this not sound borderline fraudulent? How can a practice go from being general practice to specialist without undergoing major changes. If they are a specialist now, how were they not before?? Anyways, I just needed to vent this out I guess. Any help or suggestions are greatly appreciated. God bless the American Healthcare system.

Location, North Carolina Our family has a marketplace health plan with Blue Cross. It includes free dental for children under 18. I bought a marketplace dental insurance for my husband and I but didn’t include the kids because they had the free dental on the health plan. I have been trying to make dental appointments for the kids, and of course, there is a very limited number of dentists on the list that are in network. I have called a couple to make appointments and I keep getting told the same story. Blue Cross completely ghosts the dental office when they try to submit claims so the dentists won’t bother billing them anymore. If I had known this, I would have just added the kids to the dental policy I purchased for my husband and myself. Of course open enrollment is over so it’s too late now and they haven’t really had a change in circumstance except that their coverage only exists on paper and is impossible to use. Now my only option is to pay out-of-pocket for their dental care. Anyone else experienced this? What are my options?

I got diagnosed with sleep apnea and I was delaying my treatment because I found out that its very expensive. After a few months, the cpap company based in Houston, TX reached out again that my deductible has been met and I just owe 171$ and then insurance will take the charges. After I started my sleep apnea treatment, I got the call again from the medical company that they made a mistake on their end and the benefit information was not correct. So now, they are asking me to pay 45$ for supplies and 65$ for cpap rental every month till the payments are complete. I am just a loss of what the hell is this! I get screwed up and left with more charges for a treatment which was quoted wrongly to me. I called Blue Cross Blue Shield OF TX and they said they cannot help me. My current insurance is ending in one month and I am changing insurance from next month. So, it doesn’t make sense why pay deductible towards an insurance which will not be there in 30 days. What are my rights?

On March 11th, 2024, I had an outpatient surgery procedure done. Flash forward to today, April 8th, 2025 and I just received a bill for over $3000 for this surgery. The bill states that the surgery cost overall was $20,000 and my insurance at the time paid for ~$16,000. I was covered under United healthcare and this coverage ended about 5 months ago. Here are my questions: 1. Why am I just getting this bill now? Is this even legal? (I live in WI) 2. What would be the first step to getting this figured out?

I am due to give birth end of May. The hospital that my obgyn is partnered/contracted with is where I went on 03/01 because I had a pregnancy scare. I went straight to Labor & Delivery and was there for a couple of hours. The on-call obgyn is the one that saw me. I have NOT received a bill yet, only an EOB from my primary insurance, stating that the claim was denied. In the EOB- it was stating that the hospital is an out of network facility. However, I’ve spoken to my insurance directly few different times who said the hospital that I went to indeed is an IN-NETWORK facility. Now the last agent I’ve spoken to today told me “address where the service was rendered is confirmed to be outside the network for the facility. Here is what adoress of the facility showing on the claim” and it’s a complete different address than the hospital I went to, like in a whole different state. The first agent that I spoke a couple weeks ago stated the claim type says “outpatient hospital non contracting”. The last time I tried contacting the hospital themselves, the agent was saying I need a bill/statement account number, which I didn’t and still don’t have because I was never sent a bill as of today and he said to wait until I get a bill. It’s been over a month and I still haven’t received a bill from the hospital from when I went to 03/01. I was going to explain my situation and how I still haven’t received a bill but the billing office is now closed. I do have secondary insurance but they didn’t even receive a claim from hospital, which I am assuming they didn’t even bill my secondary. I’m just so confused and overwhelmed! Does this sound like the hospital submitted the claim incorrectly?

They have declined every single submission I have made, saying out of network on everything (including doctors that are on their list). They won't even apply out of network payments I have made myself towards deductible. The insurance is a joke, I have to resubmit everything multiple times. I've been a massive fan of ACA till now (blue cross, Capital, etc). Is there anyway to get out of this insurance?

Update: Thank you for all the responses and suggestions. This is my first time ever dealing with insurance so was a little confused. I believe I have figured out what the issue was. I was seeing an in network gynecologist and they requested I get an ultrasound. The gynecologist had me scheduled with the hospital but said I can cancel and find another provider to try and find a cheaper place. I found an imaging clinc that says online that they take Aetna and so I scheduled with this place. They took my insurance information and I called them 3 times prior to my appointment to confirm the price of the service. They had stated the service was $245 every time I called and that I wouldn't owe anything more then that. I went to the clinic and before getting the ultrasound done again asked about the price. They said it would be $245 and so I swiped my card. I asked again if I would get another bill later and they said no that this is all that I would owe. I did the ultrasound and before I left I had them print the bill. They printed it for me and it shows that the good faith estimate was $245, which is what I paid upfront. A month later I received a bill from the clinic for $400 and upon checking the insurance claim I see $400 going to deductible and another $401 saying "pending or not payable" with my total share being $801. It seems my insurance is not covering anything. I had no idea that they would not cover anything or that this place was "out of network" as it literally says they take Aetna. I was reassured multiple times that the $245 was all that I would owe. I told them many times that I would cancel my appointment if there is the possibility that I would be charged more. The good estimate bill doesn't even show the actual price of the procedure nor how much my insurance would cover. I am so mad. How do I debate? Do I file a complaint? It also seems like my insurance is unaware that I've already paid $245. Please help!!! Another $800 bill on top of the $245 is insane.

Hi I’m an international student currently in the U.S. on a STEM OPT extension. Recently, I was admitted to the hospital due to severe pain, which turned out to be a kidney stone. I had to undergo surgery, and now I’ve been hit with a $50,000 medical bill. I have ISO insurance, but they’re refusing to cover the charges, saying it’s a pre-existing condition—even though this was the first time I ever experienced it and didn’t know about it before. As a student, I don’t have a high income, and this amount is overwhelming for me. I’m looking for any advice or guidance on what I can do to get help with this bill—whether it’s negotiating with the hospital, financial aid, or any legal options. Any direction would mean a lot right now. Thank you so much.