Cost sharing and out of pocket costs are increasing a lot as well. After running the numbers, I’ll be spending a minimum of $1,750 more on my healthcare next year.

One of the leading reasons my employer provided for this was a massive increase in GLP-1 usage. The government should (but won’t) negotiate maximum prices for GLP-1s. TBH at this point I really wish I had the option to enroll in a plan that didn’t cover GLP-1s for weight loss.

Anyone else experience high increases in premiums for next year? Open enrollment for my employer is next week. 29% increase in premiums across the board (Cigna)!

I currently have the top-tier PPO but there’s now a $6000 per year delta between the PPO and high-deductible plan. My family is pretty healthy, might make the switch and toss some money monthly in an HSA.

Edit: this is my employer’s group plan. 37k employees. Plan is for me (early 40s male) and 3 kids under 12. None of us have any ongoing medical conditions.

Hey guys,

I’m not to well versed in health insurance, and I’m wondering if you may all help me out…
I’m currently on a BCBS PPO family plan through my employer (me, wife and son)And I’m paying $1200 a month and it’s becoming a financial burden.

I was wanting to do a HMO to save but heard it can be worse especially if my wife and I would like to have another child. But at the same time even with the PPO plan we couldn’t afford one anyway so I might want to hold off.

I have a pre existing condition which I take Testosterone. But that’s the only thing I currently have.
Are there surprise bills with the HMO plan? I know the major benefit for me is the initial savings.

Anyone that has switched from PPO to HMO how was it?

Thinking to take New Jersey Accident and health insurance exam, had anyone done this recently. I need suggestions to pass the exam.

So I needed to use an urgent care in July, and I chose one that UHC said was in-network. A couple weeks after the visit, I get a note in the mail congratulating me that the CT scan I got was an approved. Great, right?

But then a couple weeks after that I get the claim in the mail, and it says it's denied. But it also shows what I owe to be $0... how does that make sense? The codes on all the services they provided were PF, P5, and PW (the PW was just for the ct scan.) According to the letter, they wanted more medical records to be provided.

I assumed this was something that the urgent care and UHC needed to hash out themselves... but it's been quite while since I got that claim denial in the mail.. a little over a month, and no new claims have been submitted.

What is going on here? Do I actually owe nothing? I'm scared Im going to get a bill in the mail way down the line because the cost of the visit was just shy of $3000 and I can't afford that.

Is there something I'm supposed to be doing here? How come I got a note saying the CT scan was okay, but my claim is denied? UHC was worthless.. the chat guy I was talking to (if it was even a real human) said it was my job to get the urgent care to provide medical records.. but how can that be true? I dunno how to make that happen.. and he also said I'm on the hook for my bill if it stays denied. But the EoB clearly said I owe $0.

Super confused and super worried right now.. has anyone else experienced something similar, or know what is going on?

My private doctor added about a dozen diagnosis codes for conditions I haven't been evaluated for- saying it's needed to get my labs covered by insurance. Some are scary sounding, like long-term use of an injectable medication I've never taken, and conditions that, from my research, the ordered tests can't even rule out. I asked them to remove the codes, but now I feel like I'm over thinking things. Are my concerns valid? Could these affect life or disability insurance later?

I am going to start this post by saying I am already kicking myself for going this long without checking the mail.

I checked the mail box in my apartment complex for the first time in months and saw that I have a medical bill in collections. The bill is from the lab within my doctor's office. At the time, I received the EOB from that visit, and paid it in full assuming the labs were a part of my visit and never looked back. Now it is months later and I am seeing that I have been receiving letters from the lab (and now collections) for this bill.

I go onto the lab billing portal, and surely enough there is my bill a little over $1000, however for some reason they did not bill my insurance. Every visit since then has been billed directly to my insurance and covered in full but for some reason my insurance was not recorded at that visit and I was billed instead.

I understand that this is completely my fault for not catching it sooner but I won't be able to contact my insurance until Monday and I am wondering if there is any way that this can be corrected. I am prepared to take on this responsibility but I wanted to know if there is any way that I can work around this.

The time for filing with my insurance is 120 days and I am well beyond that at this point. If I have a case that I can fight at all, I would like to know.

TIA

Some info here.
I am paying off student loans and I make less than 40k a year.

Hello everyone,

I received this letter from “The PHIA Group”. I am unfamiliar with this field, and was hoping someone here could help clear things up for me.

I was not in an accident - I had surgery for a torn labrum/bone lesions that just developed overtime, so I presume I just need to select “ongoing condition”. The second page I believe I should just leave blank.

I’m mostly interested with what are the ramifications of this/what comes next. Obviously I don’t want to open myself up to any financial costs. Is this something I need to contact my insurance provider about, or consult with an attorney?

Summary: Managed Medicaid Plan. Contractual Denial. Member Responsibility Zero. Provider Billed.

Today, I just received a bill for a pulse oximetry from 5/17/25 for $38.00. This appears to be the first invoice as its not past due. I've checked my EOB and it indicates Remark 15. Contractual Denial. This service is not covered by your plan.

Total Member Responsibility is 0.00.

I probably signed something back in May 2025 that I would be responsible but am I actually responsible?

$38 dollars is not a lot of money generally but for me right now and for the foreseeable future it is.

Is it easier to just pony up the cash or to call them and be like "insurance says zero"? What are even the options here? Most of the time whenever I see an EOB like this, I don't get a bill for it. This insurance company doesn't say denial or approved for EOBs, everything is PROCESSED. It's the best insurance company available in my area. It only services Western New York. Company is based in Kansas, or at least that's where they send billing from.

This is the first time I’ve had to use my insurance beyond a yearly appointment or basic primary care physician appointments. I broke my ankle and had an emergency visit- orthopedic surgery and CT scans/ X-rays. I would think that 472 would reflect on my deductible as well as the out of pocket. Is there something I’m missing?

The CoveredCA website makes it really hard to get quotes for different scenarios. How much for our family of four? What about just my wife and I? What if we make over the 400% subsidy limit? What if we make under it? etc. Any tips or suggestions for gaming out various situations?

So I went to the eye doctor this week. It’s been six years since I’d seen them, but I had an issue I thought needed an MD’s attention. Six years ago, they mentioned cataracts, so it’s a good time for a check. (Yes, I had an optometrist exam in that six years and new glasses in the interval. I’m not neglecting myself THAT badly.) They tech put me through the regular eye check before I saw the doctor and worked up a prescription. The doctor checked my eyes, addressed my other concern, and brought up cataract surgery, but not in detail. We agreed to meet again in six months.
I paid my copay and was then sent to the optometry desk to pick up my prescription. Eyes were dilated; I couldn’t see to shop for frames and want to shop around. I asked for my prescription, but the optometry tech gave me a song and dance about not being able to give it to me since I didn’t have an eye check appointment. What the heck did I just have?
She wanted $75 to give me the prescription, claiming she couldn’t bill for the prescription exam on the same day as a medical eye exam. “I don’t know why. They just did both back there.” She actually said, “Yes, I know this insurance stuff is confusing.” “No, ma’am. It’s not remotely confusing. I mean no disrespect to you, but this sounds like a scam.” I left with my $75, but without my prescription.
What the heck? Don’t I have the right to my medical records? Why bother putting me through the entire prescription check if I can’t have the script? Anyone?

I did not have a job so got free insurance through NJ family care and United Healthcare. I started job and got first paycheck in June end 2026. Since then I did not use any medical service. Around July end I informed NJ family care about my income and to end my free insurance. They sent me a letter requesting paystubs to verify my income change. I haven’t sent them yet. I called NJ family care before few days and they mentioned they are still waiting for the paystubs and the coverage is active. Is it wise to use any medical service or wait until the free insurance coverage gets canceled? Thank you

Hi all!

My employer is changing plans next year. We're staying with Anthem, just general plan changes. I am confused on which is the best - math seems to point out to the HSA, but I don't know.

Here's my choices. I have ADHD but no other health issues and have not seen a doctor for anything but for an annual exam for the past 3 years. My ADHD has been untreated for the past 3 years but I am considering going to go back to my PCP for medication management in 2027, but I have not decided on this yet.

I am not considering the EPO at all (~$25 more biweekly than the PPO). I am only considering the Flex PPO and Advantage HSA. Rates: $82 biweekly for Flex PPO; $62 biweekly for Advantage HSA. Employer contributes ~23.XX biweekly ($600 a year) to the HSA only for the HSA plan.

Prescription is covered from the start for the PPO and 20% after deductible for the HSA. Predicted cost for my ADHD RX using the Caremark estimator is $~25 a month for the PPO and $~70 a month for the HSA plan; could be more for the HSA, I am unsure tbh.

Visits: I would see my PCP 5-6 times a year for medication management for a cost of $25 a visit for the PPO. I will assume the visit will be a negotiated rate of $120 as a baseline (not sure tbh), so we'll say it's a total cost of $25x6=$150 for PPO and $120x6 = $720 for the HSA.

Adding these up, and I get this:

PPO: 82x26 = $2132 premium; 6 visits at $25 = $150; 12 months of meds at $25 = $300; total of $2582.

HSA: 62x26 = $1612 premium; 6 visits at $120 = $720; 12 months of meds at ~$70 = $840; total of $3172 - $600 HSA = $2572, so $10 cheaper

This seems like a wash. I am just curious if my math is wrong. There's always a chance I don't actually decide to seek treatment for my ADHD (long med management history from age ~12-23), and in that case the HSA has an obvious $~1K advantage, but I feel like it's 50/50 that I will. There also always is the chance that something out of my control happens, too. What is the best choice here? Please correct my math if it is wrong. thanks!

**I don’t know if I am posting this in the correct place, so please delete if not allowed.**

My daughter was eligible for one $50 gift card and one $100 gift card.

We got the first one and every month they have sent one since. I will admit that I have used 2 of the $100 gift cards for 2 of the $50 gift cards.

They sent another $100 gift card yesterday and I tried to call them but the first time I got hung up on.

The second time I didn’t get any actual answer to my question which is… whether they knew they were sending it a 3rd time.

Can I get in trouble for using this one? I don’t want to get in trouble for using them, but I also know that usually once a gift card has been issued, the funds can’t be returned to the sender.

I don’t know what to do and as I said, my phone calls have essentially been unanswered. Please help me navigate this

Hi so I’m hoping someone can give me advice on what to do here because I’m terrified.

For the past 3 years, (5’3” 27F) I have been on Mounjaro to treat my PCOS with severe insulin resistance along with lessen the inflammation of my endometriosis. Yesterday I got the call from my provider that insurance no longer covers any kind of GLP-1 for anything other than type two diabetes.

The thing is before I took this medication I was 230 pounds and prediabetic. I was constantly restricting and exercising but genuinely nothing worked until I started this medication. I finally feel good both inside and out and I am scared to lose that.

Does anyone know what I can do? I have an emergency appointment with my endocrinologist next week but I’ve already called insurance and they don’t give a crap about my condition or that if i am off this long enough, I will become diabetic.

Thank you so much

My wife and I are currently living in New York City. She is in J-1 status and works as a research associate at a medical center, and I am in J-2 status.

We are trying to extend our health insurance coverage for one additional month. Unfortunately, we have had difficulty finding a suitable insurance plan because several providers do not accept applicants who are already living in the United States, particularly in New York.

My main concern is that we might have a two-day gap in our health insurance coverage while arranging a new policy.

My questions are:
1. If our insurance expires, what are the potential consequences of the two-day gap?

2.  Could such a short gap lead to termination of our J-1/J-2 exchange visitor programs or affect our immigration status?

3.  Could this affect my wife’s employment at her institution?

4.  Are there any other insurance providers that accept J-1/J-2 holders who are already living in New York and need only one additional month of coverage?

I would really appreciate hearing from anyone who has experienced a similar situation or has knowledge of the regulations.

This year is the first year that I enrolled in my own health insurance. I pay $53/month. I received a form saying that I can change my plan, or stay with this plan but the monthly premium could change.

For 2026 the total is 271.41 minus tax credit and state premium = $53 which checks out.

For 2027 its 308.04 minus tax credit and state premium = $20

This seems extremely low, like unheard of.

its the same plan, so its not possible my benefits could change right?

I am not very experienced with how it works.

But it being $20 per month just feels like somehow I am going to get screwed

Thanks for any insight

I was in the ER over a week ago, diagnosed and sent home with treatment. A few days later, I got worse. Treatment failure. Returned to the same ER, they said I need to be admitted for IV abx.

Spent two nights. Ordered nothing by mouth.

The morning after discharge Oscar emails me the denial letter for lacking medical necessity. I called and complained and they said I was too upset to talk and transferred me to an Optum therapist. Totally useless by the way, ChatGPT did a better job at calming me down.

Later, I enter a chat in the Oscar app, get a human, and ask them for who the clinician was that reviewed my case as the letter only had an 13 character identifier. She attaches a letter and it only has the same characters. So I reply back and… nothing. That was 9 hours ago and the chat shows as still active.

I also asked for the name of the therapist, and was directed to call Optum who refuses to give me their name saying I wasn’t talking to a therapist.

I thought I was entitled to have the names of people who are active in my healthcare.