Cigna denied my claim for a “periodic oral evaluation-established patient”, but approved adult cleaning (two per calendar year). This was the second examination and cleaning I got in the year. Reason for denial is “N4 - This claim is denied due to lack of information. If you would like to have the claim reconsidered, please submit the information requested” I contacted Cigna customer service twice and both agents said they didn’t know what the information requested was and provided no course of action. Who can I reach out to to understand what additional information is requested since Cigna doesn’t know?

Hello, I have Aetna insurance and my daughter was prescribed to go for hypoallergenic formula. I spoke with agents, doctor office submitted required docs and they received a fax saying it’s covered. They directed me to Coram where I can order fomula. Coram and Aetna coordinated and determined I’m covered at 100% Now, in my Aetna app the claim is denied and my share is $6536. I have not received a bill from the provider(Coram). I’m panicking Please tell me if I owe the above amount?

I just had my first mammogram (just turned 40). My breast are extremely dense. Otherwise, normal/negative mammogram. I did the ABUS and now they want me to come back for additional ultrasound due to artifact versus true mass. At this point, I don’t really trust the ultrasound because of how dense my breasts are. The ultrasound lady kinda laughed at how white the screen was after she did the imaging. So here is my question: has anyone with extremely dense breasts ever gotten a screening mri of breast covered for extremely dense breasts? Not really counting on being able to do it as a screening test at this point because I’m probably now only able to diagnostic tests due to the ABUS findings. Asking for future testing mostly. I called BCBS and they were useless. I asked “if I have extremely dense breasts and my doctor puts that as the ICD:10 for a screening mri of breast will it be covered?” It lists screening mri of breasts as covered on my EOB. The lady on the phone couldn’t answer me. Appreciate any insight. Thank you!

Location: Michigan At a loss here. Just received a statement from my health care provider that BCBS denied my iron infusion from January and that I owe $11,000. I had iron deficient anemia during my pregnancy and iron pills didn’t do anything to raise my levels so my doctor ordered iron infusions. I didn’t think anything of it as during my first pregnancy in 2023, I also had iron deficient anemia and my iron infusions were covered by my insurance but it was through a different health care provider. BCBS is claiming that the treatment I received for iron deficient anemia isn’t covered. The procedure was coded as q0138. Do I appeal? Do I call my health care provider and see if they coded this wrong? Owing $11k for something that’s been covered before is stressing me out. I never would have agreed to iron infusions if I had known it would be denied. I cannot afford an $11k bill…

I posted a couple of weeks ago about an ongoing claim between the hospital where I had ACDF surgery at on November 1st and my health insurance, UHC. The latest development is that UHC has sent yet another claim letter to the hospital , asking for specifics on an unidentifiable CPT code. Based on a prior claim letter, I suspect its CPT code J8499 which was sent to UHC to the tune of almost $14,000 out of a nearly $30K claim. I had read that this code is used for oral drugs but I can’t imagine what they would have given me that would have cost that much. The claim is on hold for 90 days yet again, but I’m getting spooked just like I did a couple of weeks ago. I mean, this claim has just dragged and dragged because UHC has to keep asking the hospital for information and I just don’t get what’s so hard in terms of the hospital giving them what they need. Anyone familiar with the code and its use?

So I have really bad neuropathy and have had for like 15 years. Can't feel anything below my knees. I developed a foot ulcer that was just not healing and after going to a foot specialist for 3 years my GP sent me to a wound specialist in Jan. My company had just switched to united health care so I wasn't very familiar with them. I went to the wound specialist every week or every other week for 2 months and I was actually seeing a lot of improvement and was feeling pretty good about it when my insurance told me they were denying a lot of the services so now I owe over $6,000! And this is on top of the $200 I had to pay every time just to go see him as a specialist. But the things that they are denying are things like the wound pad and the gauze that they wrapped my foot in for me to leave the office. The Doctor cuts away a lot of old flesh every time and its on the botton of my foot so am I just supposed to leave his office with a big open wound? Am I supposed to bring my own gauze? It's also saying that I got a device several times, but I never got any type of device. Also the amount that the doctor's office is charging for just a little bit of gauze is insane. It's saying that the gauze or pads are 16-48 sq in and they were just small squares so maybe my doctors office was padding the bill, but I'm not sure. I've tried appealing it but what else should I be doing? I've stopped seeing the doctor because I can't afford that so now I'm just back to not healing and having a constant worry that it's gonna get infected and I'm going to end up having my foot amputated. The claims say things like: Service description: A saline- or hydrogel-soaked gauze pad, 16-48 sq. In., used to cover a wound. The dressing protects the wound. Claim codes: Benefits for this service are denied. Your plan does not cover this medical supply, prosthetic, orthotic appliance, or durable medical equipment. Service description: Any one item used during a surgery. Claim codes: Benefits for this service are denied. Your plan does not cover this medical supply, prosthetic, orthotic appliance, or durable medical equipment. Please refer to the Exclusion and/or the Additional Coverage Details of your plan document for additional information. (CAD128) Service description Any sealant, protectant, moisturizer or ointment. The product is used no to protect nntont the the skin ckin against against tears tears or or breakdown breakdown caused caused by by tape or other adhesive material. Claim codes: Benefits for this service are denied. Your plan does not cover this medical supply, prosthetic, orthotic appliance, or durable medical equipment. Please refer to the Exclusion and/or the Additional Coverage Details of your plan document for additional information. (CAD128) Service description: A sterile pad, 16 sq. In. Or smaller, made of gel fibers to cover a wound. The pad is used as a protective dressing Claim codes: Benefits for this service are denied. Your plan does not cover this medical supply, prosthetic, orthotic appliance, or durable medical equipment. Please refer to the Exclusion and/or the Additional Coverage Details of your plan document for additional information. (CAD128)

I have medi-cal through anthem blue cross in association with LA care health plan. I have never had Medicare part B. I had a ultrasound in october 2024 which was approved by my primary care provider. I just got a letter today from the centers for medicare and Medicaid services, fargo ND. It is saying that the ultrasound was not approved and i may be billed 220$ It also says i have not met my part B deductible of 240$ Again, i don't have medicare part B. Im not experienced with these insurance issues. I dont know if medi-cal already paid this or not, it's been almost 6 months. Is this medicare preparing to bill me for services already paid by medi-cal ? Thank you, input appreciated.

I was insured through United Healthcare via my employer in Texas. My employer paid premiums monthly to cover the following month’s insurance (monthly payroll). On March 12, 2025, all employees were notified via work email that we were being placed on unpaid furlough effective immediately. We were told we would still be paid for work performed from March 1–11, with payroll running as usual at the end of the month. I didn’t hear anything else from my employer until April 2, when I received a letter in my personal email stating that we had all been officially terminated effective March 21, 2025. The issue is that I saw a specialist and had exams done on March 24, unaware that I had technically been laid off on March 21. The same day I received notice of separation (April 2), I called United Healthcare to check on my coverage. They told me my insurance appeared to be active and didn’t show any indication that it had ended. However, when I checked the United Healthcare app today (April 5), it now says my coverage ended March 21, and they have denied the claims from my March 24 visit. I had no way of knowing my coverage (or job) had ended at the time of the appointment. I’m concerned my employer backdated the termination or insurance cancellation, and I’m now stuck with bills for services I reasonably believed would be covered. Has anyone dealt with something like this before? What are my options here? Should coverage have continued through the end of March? Additional information: I have since found out my employer filed for bankruptcy, without letting any of us know, and none of the employees were paid for their time worked in March 1 - 11th. Any help or guidance would be appreciated I’m unsure how to navigate this situation.

My daughter is going through a lot of PT/OT that is being billed via a local hospital outpatient center. I talked to the insurance company administrator for this portion of my insurance and I ensured that the provider (hospital) we were going to would be treated as in-network (see \*\*\*\* paragraph below, as they guaranteed it and I couldn't find a provider that would do this within 30 miles of my home). To do this, they had to negotiate and worked out an agreement. On top of this, the provider has to get pre-authorization in blocks of visits so no visit has occurred without someone at the insurance company pre-authorising these. My certificate of coverage does say that I do have PT/OT benefits but there's two kinds of it, one that is based on a hospital stay and one that is based medical necessity . They both have the same copays and costs, so it shouldn't matter but regardless, there are two ways one can get PT/OT via my insurance plan. The provider has submitted these PT/OT requests to the hospital administrator Anthem. Anthem has rejected these with the code: "\*00NYP Your policy will cover this service only if it follows surgery or a prior hospital stay for the same condition. Please refer to the section of your contract or benefit booklet that describes the coverage for this type of service." \*\*\*This is what my certificate of coverage at a glance says about CT/PT/OT: "Chiropractic Treatment, Physical Therapy and Occupational Therapy Network Coverage Each office visit to a network provider, including related radiology and diagnostic laboratory services, is subject to a single $25 copayment. No more than one copayment per visit will be assessed. MPN guarantees access to network benefits. If there are no network providers in your area, you must contact MPN prior to receiving services to arrange for network benefits. Therapy must be prescribed by a qualified provider." AND "Physical therapy following a related hospitalization or related inpatient or outpatient surgery is subject to a $25 copayment per visit. Physical therapy must start within six months of your discharge from the hospital or the date of your outpatient surgery and be completed within 365 days from the date of hospital discharge or outpatient surgery. Medically necessary physical therapy is covered under the Managed Physical Medicine Program when not covered under the Hospital Program (see page 12)." From looking at how they are capitalising things, I believe Managed Physical Network/MPN is yet another administrator for PT/OT like United Healthcare, Anthem, and Carelon for medical, hospital, and behavioral. Am I right? So they are not sending it to the right place? Or it is coded incorrectly? I'm wondering why this provider is having so much trouble getting reimbursed the right away since there's been a lot of communication already with SOMEONE and it should all be set.

I had a fsa in 2024.. before the plan expired I submitted two big expenses that were “authorized”.. however, money never got deposited to my account. Now they are saying the claim was valid but the amount was paid toward “unverified” receipts. Now that the plan year is closed they are refusing for me to submit receipts. The claims that were “unverified” were hospitals and doctors. Is this normal? Anything I can do? This is over $1200 in lost money