plan benefits

What does a health insurance with a $0 deductible and $8,700 out of pocket limit mean if it’s a $0 deductible?

My billing situation is a nightmare. For a $12,000 out of network charge the insurance company is claiming the Medicaid rate is $4,400 and that is all they will pay. That would be fine with me if they negotiate that with the hospital but they didn’t. The line in the sand was drawn with me and...

So comparing the two plans I’ve been provided (see info on both below). The first one called “lower deductible” is $71/ biweekly and second In network only, $109/biweekly. With that information I read it as that the higher tier (In network only) costs me an additional $912/year to save $250 in...

I just took a new job second week of April. Insurance is retroactively active on day 1. Let's call this insurance a. Am currently covered by my husband's plan, called insurance b. Third week of April, I have a biopsy and find out I have cancer. I just got my insurance A information today. I...

Paid the bill after insurance immediately and today received a new bill for 800 for the same procedure. From what I received from surgery center it looks like the claim amount was changed. A month after that procedure another family member had a procedure. But the insurance isn’t taking into...

I am enrolling in insurance for 2024, and am having trouble deciding between 2 plans. I don't want to make a bad decision for my family, so I would appreciate any advice! I have a family of 3 Plan A: Deductible: $4k individual, $8k family OOP Max: $8,150 indiv, $16,300 fam Office visit: $25...

I am in very bad pain. I cannot afford or need to visit the emergency room, but searching on their site tells me there is no urgent care available near me after 5:00 on a Saturday, in the heart of Los Angeles. I went through all the phone calls, connected from one fucking voice menu to another...

Hi! I’m having knee pain and I need to get a MRI and I need to do PT. I’m only $400 away from meeting my $3,000 deductible. My out of pocket max is $4,500. I want to make sure that if I get this MRI and go to PT, the absolute most I will pay is the $400 remaining deductible. The SBC says that...

Hi! I'm an immigrant and haven't been living in the US for long. I recently submitted a stool sample to a lab for an H.Pylori test (which thankfully turned out to be negative). I looked up the cost beforehand for these tests and it said that they're between 11 and 195 dollars nationwide. I have...

I have a job that is giving me health insurance for the year, but idk if I’ll have it after then. I am under 26

I was wondering if someone could help me clarify a few quick questions I had about private insurer bargaining? In particular, - Do they bargain with each provider 1 time, or when they bargain, do they bargain for separate contracts for each plan (e.g. HMO, PPO, etc.) Like, if I'm a doctor...

I had a procedure that required pre auth originally scheduled for 2/26, but the provider cancelled on me so we had to reschedule to 3/7. It happened on 3/7. They obtained the pre auth on 2/9 (when it was supposed to be the original date of 2/26) and the date range listed on it are from...

Hey gang, had a doozy of a trip to puerto vallarta. With no prior warning when going to bed one night, my wife started screaming in pain, passing out, bleeding downstairs, and vomiting and required an ambulance and a trip to the E.R. After a CT scan out she had an ovarian cyst pop. The hospital...

Hi, I'm in Georgia, USA, and have a pretty crappy health insurance plan (Aetna CVS Health marketplace plan). Previously, with a different but equally crappy plan that did not have good coverage in my area (i.e., within 50 miles) for some basic things like speech therapy, I was able to get...

I used to work full time and I had Horizon blue cros blue shell. I left that job on July and become full time student so, I got Horizon NJ health. Wen I found out I'm pregnant I tried to make an appt with a obgyn but, they denied the service because in the system appears I have both insurances...

Context: I am trying to get a breast reduction surgery that I need to prove is medically necessary covered by insurance. I have no reason to believe I won’t be approved, but I am waiting for the final call to make it official. Hey y’all, Today I await a phone call from an insurance rep who...

I started my first job and am also on my parent's (excellent) health insurance. The new job has employer-sponsored plans - I would pay $0 in premiums - or I can waive it and only have my parent's insurance. The only thing I am worried about covering is my 2x/week therapy which would be out of...

My insurance coverage for X-rays is very vague. My benefits page shows Radiology/X-ray Facility as no coverage, deductible applies. But Radiology/x-ray facility- Freestanding Radiology is a co-pay of $150, Radiology/X-Ray Facility-Radiology Imaging Center is also a $150 co-pay. My son broke...

Just a bit of background. I have a son who has been going to specialist, ENT, allergist, and now going to endo. I have a baby due in June. Questions: Looking at the table below, if there is no coinsurance after I hit my deductible; why is there still an Out-of-pocket maximum? So for the PPO I...

Apologies if this is not the right place, but I’m new to this and need help understanding my options here. Went and got an X-ray for some constant knee pain and my orthopedist referred me for an MRI on the area due to noticing significant subluxation of my patella. Cigna approved the X-ray, but...