Hey Folks so I'm 30+, I had Star Health insurance earlier however I don't see that they are updated on offer good enough health claims for women specifically. I'm searching for a good insurance which caters to medical needs of women 30+ and over where things like Ovarian cancer shots, PCOS/Fybroid related surgery etc can be claimed. I had a very tough time convincing the policy manager at Star bazar to accept my claim for the same while it was a procedure suggested by the doctor herself. But clearly they seem to know my body better than the actual doctor (LOL) Could you recommend some insurance companies that do cater in the above factors and have better facilities available especially for women.

I’m getting fed up with navigating these PPO plans. 3 tiers in network, out of network. Lab fees from pcps being sent out of network and charged outrageous amounts specialty providers working out of our primary hospital apparently “not covered”. I know there are others on here with worse situations. Surely there has to be a health insurance negotiator/broker that will help correct and track these charges to make sure we’re not getting wrecked by these incorrect charges. Something like a rocket money that will work through the fine print in the insurance contract and make sure we’re not being overcharged. I’m here for all the suggestions. We use Ascension smarthealth for reference and if you’re curious about it, stay away.

I have messaged optumrx several times to stop automatically filling medications for me. I would like to do it manually because many times my doctors send orders for as needed medications that I use maybe once or twice a month and have years worth of usage from constantly having it sent. Despite attempts, they never fix the problem. What can I do? Age 28, state FL, gross income 80k

After a surgery consultation, my doctor submitted a pre authorization request to my insurance, Anthem (North Carolina). I believed it had been sent on March 17th, so I called my insurance to check the status last Friday. However, there was no record of any pre-authorization being sent. This turned into the insurance calling the office, and they confirm it was sent March 24th (so it is confirmed by both the office and the insurance rep who called). Now today, I called to make sure the information had been updated, and that the pre-authorization had officially been received. Once again, they say there is zero record of any pre authorization. This is my first time having to go through this process, and I'm just super confused. I know the expected date to hear back is within 15 days, but I at least thought the request would be on file. I don't want to have to call again, but I'm getting worried that the request won't show up in the Anthem system. Plus I can't schedule surgery until this is approved, and I need it done this summer so the longer this takes the more nerve wracking it is. Basically, is it normal for my insurance to have no record of this pre-authorization request 14 days after it was sent?

I have a high deductible UnitedHealthcare plan through work and my primary care doc referred me to a local radiology clinic for a mammogram and ultrasound for a lump in my armpit (everything turned out okay). I got the bill the other day and almost choked, $635! I called UH and they said since it was billed as diagnostic and they don't offer any discounts, they only paid about $50 and I paid the rest, essentially it barely mattered that I had insurance. I am 35 so they aren't covered yet as preventative. Should I appeal this? It's so much money after being laid off for 7 months before.

Hi I got nexplanon and was billed by planned parenthood for $400, my insurance Community Health Plan of Washington states it covers birth control, but I’m getting charged $400 for the insertion? Is this correct or should I be completely covered by my insurance?

My Aetna plan will be removing Miebo from coverage in the new plan year effective 7/1/25. This drug is the only FDA approved drug proven to treat the evaporative component of dry eye disease. There recommending I switch to Restasis , which is a good drug, but only treats the production of tears and not evaporation. Since there is no generic and no FDA approved alternative , are there any legal actions I can consider, or the plan can just do whatever they want and I’ll need to find another company that will cover the plan. The drug is about $800 a month, and while I can make it work, I would prefer for it to be paid for. I could also attempt to back door the European Version EVOTEARS from Germany for $20 a bottle.

Hi all - I was wondering what the likelihood that my Appeal that I finally sent in will be successful or if I'm just going to continue getting the runaround from United Healthcare. At this stage is it worth doing anything else (or do I have to wait until the Appeal plays out?) Some details... The claim that I filed with United Healthcare had all the correct, relevant, and necessary information including the in-network Tax ID, the Practice’s pertinent information, the doctor’s name, itemized receipts (two – one paid with FSA and one paid with credit card), and other pertinent claim-related information. United Healthcare processed the claim as out-of-network, but the Practice is in network, which made me receive +/- $3,000 less in reimbursement than I should have (due to that money going to an out-of-network deductible). I have called United Healthcare more than 15 times now across 3 months to see what else is needed and to fix the wrongly coded EOB and I’m always told that United Healthcare made a processing error and will fix it – but it never happens months and months later. The EOB erroneously states that this was an out of network event, but everything was in-network, and I have coverage for the procedure on my plan. Once again, every time I have called United Healthcare, they have told me that I’m right, that they are ‘backing out’ of the old claim and will fix it, and every time nothing has been fixed. I just called earlier this week, and the 15th advocate I spoke with (after taking 20 minutes to look over all the times I called and notes) said I was 100% absolutely correct, I should have received an EOB saying it was in-network, and the determination was wrong, but folks keep coding it – inexplicably – as out of network. She encouraged me to appeal....which I just did. Expectations of what may come next? Thank you.

Hi all! I’m trying to submit out of network bills to Oxford for my sons intensive out patient program. I’m getting denied for this reason, “Benefits for this service are denied. Your provider has billed more units than what is allowed in one day. The allowed number of units have been processed on a different service line. (CES024)” I’m in NY also Thank you

I'm honestly at my breaking point dealing with BCBSNC. I’ve had multiple claims denied that should be routine — and I’m exhausted from trying to get clear answers. Recently, I had in-network bloodwork done that was ordered by my doctor. BCBS denied the entire claim — not even applied to my deductible — and there was no EOB at first. The exact same tests were processed last year with no issue. In Dec. I had a bad sinus infection, I went to urgent care, and even though the provider billed it correctly as urgent care (POS 20), BCBS processed it as outpatient hospital and denied the appeal. Last year, I also got stuck with a $1,300 bill after seeing a cardiologist who ordered a stress test at a local hospital. That claim was denied too, because they classified it as an outpatient hospital visit — even though it was a specialty care appointment. I’ve submitted appeals, contacted billing departments, and chased down paperwork, and BCBS just keeps giving vague, inconsistent responses. I haven’t contacted HR yet, but I’m seriously considering it, along with a complaint to the Department of Insurance. I’m using in-network care and following the rules. I just don’t know what else to do at this point. Has anyone else dealt with this kind of mess?