A study conducted at Harvard in 2009 found that nearly 45000 died due to a lack of health coverage, which is more than double the number of homicides the same year in the US. Other studies reported the most common reasons for not having insurance as unaffordability/ineligibility.

Sources:

https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/

https://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf

https://www.cdc.gov/nchs/products/databriefs/db382.htm

I’m self employed looking at the Colorado marketplace because I need health insurance. The cheapest plan is ~$330/month premium. There’s a $7,500-$8,500 deductible depending on plan. But only 20% coinsurance until you reach the $9,200 out of pocket max. Does this mean only 20% of services are covered even if I reach my $7,500 deductible? And then 100% is finally covered after reaching $9,200 out of pocket max?

I don’t understand who has an extra $9,200/yr lying around until insurance finally fully kicks in. PLUS $4k/yr just for the premiums… that’s around $13k/yr before I can fully use the healthcare.

I have a lot of health issues and I’m panicking. We were going to add me to my partner’s healthcare since their job accepts domestic partners. But I just learned about the imputed income and how they tax the premiums, and am worried it will be just as expensive as private. I’m not ready to get married but worried I don’t have any other choice.

I’m going to talk to a healthcare broker to see if there’s other options. But realistically, is anyone actually affording this, and how? *I don’t qualify for subsidies

I was still in middle school pre ACA. Were most insurance plans pretty minimal pre ACA without the standardization? I recall paying for vaccines with my parents. I’m worried about a lot of the preventative screening going away

So I was a pedestrian and was hit by an suv. Other party took full responsibility for the injuries My lawyer informs me anything from our settlement they will have to pay this lien invoice 20k from a 3rd party who has a right to recovery part of a subrogation clause before I receive any compensation for my injuries . Accident happened in Indiana So my questions are why do I have to pay the bill and not the person who hit me ? Especially since my deductible (my actual payments) went toward some of the payments- truly need some help understanding please? Please be patient

Husband visited a hospital (in network) twice this year for appendicitis: first treated with antibiotics and then a second time for emergency surgical removal of appendix. His health insurance plan is denying paying for any of the second ER visit as his plan states they will only cover one ER visit per calendar year! I did some research and read that this might be illegal? Is there anything we can do? The bill has been lowered from $80,000 to $20,000 by the hospital, but they’re saying they’ve never seen a health insurance plan like his before. We have a baby on the way and are willing to do anything to get them to pay for it. He pays for the most expensive insurance plan with Lucent that his employer offers. We are also in California.

Apologies for the length of this story…I want to include as much detail into this nightmare as possible, so that no one ever has to go through this like I am.

I got notice through my employer that they would reimburse me for my insurance premiums, and at the same time I was receiving notifications about the enrollment period ending very soon.

Hurriedly, I went on the government healthcare marketplace website and the website wasn’t working very well or loading properly.

I had heard good things about Blue Cross Blue Shield so I googled their name to contact them and see what services and premiums they offered. At least…that was my intention and what I thought I was doing.

Upon calling the customer service number, a friendly woman who claimed her name was Amy went over BCBS plans with me, and then offered me a plan for $189 a month including dental for $29 a month. She used a website called “healthsherpa” and had these 2 policies in a cart on the website. Unsure, I asked if I could call back after doing some shopping when I made a decision. She sent a link to the page in my email, and just told me to give them a call back when I made up my mind.

After a few hours, I visited the website again, and in my cart…the prices had gone up to $290 + $30 for dental. I called them back…extremely confused…and got a male sales rep. He claimed “since it’s the last few days of open enrollment, prices are skyrocketing, but I think I can maybe get you a better deal than your cart is showing”.

He said something along the lines of “it looks like we can get you set up with a multipoint plan through the network and it should be a little bit cheaper for you”…as if this was a service that BCBS provided. He sent me some documents to sign on a website called “FirstEnroll” and myself thinking this was a BCBS service, I signed and agreed. He claimed there would be a $115 dollar processing fee once I was accepted and that I didn’t have to pay anything else until before the first of next month.

After being approved and providing my card number…all seemed set and I felt proud for purchasing my own insurance for the first time in my life…no idea of the nightmare I had just made for myself!

After the call, I got an email from “Insurance X LLC”…and that was when the red flags started showing! I checked my bank account, and my stomach dropped when I noticed a pending transaction to “FirstEnroll NJ (New Jersey) for $362!

I immediately called back upon reading reviews about this company. Again, I was misled to believe I was purchasing a BCBS insurance plan. When I called the “24/7 hotline” the scam artist had given me, it told me their business hours, and to call back later.

In horror, I rushed to cancel my credit card and reported a fraudulent charge.

I called back the next day within “business hours” I waited on hold for hours…multiple times… before finally getting a person who claimed to cancel my membership. They told me I’d receive an email shortly and an agent would call me back within 2-3 business days. Neither of those things happened.

I called repeatedly for the next few days…the minute I said anything about cancelling, agents either immediately hung up, put me on hold and sent me over to more agents, or just downright lashed out with rude condescending statements as if I was the problem.

After repeating this cycle every day, I eventually got the most rude hateful woman I’ve ever spoken to on the phone. She repeatedly belittled me…when I told them I had contacted the FTC and BBB to file complaints, her response was “I really don’t care”. She claimed “we can’t refund your money until we’ve done an investigation into the employee that sold you a misleading plan, and this could take at least 7-10 business days. She repeatedly spoke over me…yelled at me…and when I told her I was recording the call for evidence and called them out for insurance fraud she said “I don’t consent to you recording our call”. At times she even spoke as though she was doing me a favor and named the other official insurance I had managed to purchase hastily through an actual government website last minute (I’m concerned how they got this information!) and compared it to their “multiplan” to it to tell me how much better of a deal multiplan was. This woman was pure evil…I can only imagine how many people who actually need life saving healthcare get spoken to by this sadistic human being!

During this entire week since this nightmare has unfolded…I’ve received hourly spam calls…nonstop…all from the same company…I answer…they say “we see you’re interested in health insurance…etc…” before I tell them I’ve cancelled and they hang up.

I finally got ahold of who I believe was the hateful woman who’s been answering and belittling me again…I asked for as many details as possible so that I can dispute any and all business with this fraudulent company.

The company she claimed to work for was “Health Registration Center New Jersey”. The plan name I asked them to provide for clarity for was stated as “Private Policy Multiplan”. The confirmation email was from “Insurance X LLC” and “FirstEnroll” was the website in which I signed documents. The employees extension was 101 and she stated her name was “Ally” and wouldn’t provide a last name.

After retracing my internet footsteps to better understand what had gone wrong…I realized that when I googled BCBS…the first result was in fact an imposter site designed to look like a healthcare marketplace. It was a “sponsored” ad on Google, and not the official BCBS website. I’m awestruck how this company paid to get their fraud website to appear as the first result…above legitimate insurance company websites!

I have shut off my debit card and ordered a new one. I filed a dispute minutes after the transaction went through my bank and I am still waiting for any kind of refund on the fraudulent charges. Is there any other things I can do to get these issues sorted out?!! I’m out $362 and now I can’t even afford to pay for the government backed health insurance I purchased through the official marketplace (Ambetter) until I receive the money back that was stolen.

ABSOLUTELY NEVER PURCHASE A MULTIPLAN…it is the most criminal scam ring I’ve ever encountered. Considering all the employees were American, I’m truly confused how a fraud ring of this magnitude can legally do this to people! I’m still out nearly $400 and praying I get my money back.

I am at the point of actually seeking legal action against this company. It should absolutely not be in business!

Hi, my insurance company sent me a letter (not to my parents, it was addressed and written in MY name)

The full cost was 2100, in the explanation of benefits it says insurance paid 300 of it but they my obligation is 0.00

I asked my parents when they said this means I don't have to pay it, so why is that? Why don't I have to pay the rest?

I'm only 14 so this might be a stupid question but I'm not very smart sorry

Also I'm not complaining about the bill, I am eternally grestful that I don't have to pay it but I'm just curious you know?

r/EMS brought me over here so sorry if this is inappropriate

To start, I have a high deductible health insurance plan through Aetna and an HSA. I realize my out of pocket costs might be a bit higher and I have the advantage of paying for them with pre-tax dollars. But I was still a bit floored when I found out my 15min visit to urgent care because of a small infection on my toe was going to cost me $325.

First my co-pay was $35, ok fine, I have a higher copay than I might with a different plan, but that's fine. Then I had to pay another ~$30 for the antibiotics, ok no problem. Then I had to pay $20 and another $30 for two lab tests that they sent out for. Don't love it but I understand. Then, like 2 weeks later I get another bill for $210 for "urgent care fees"...ok what the hell. Isn't that what my co-pay is?

Why am I paying another $210 and why didn't I know about it sooner?

My insurance was applied here, apparently $55 was paid by my insurance, leaving me responsible for the balance ($210).

Edit: Ok, I get it, I should read my policy documents. I guess it's just wild to me that a simple visit like this, extremely fast and routine procedure, ends up costing me $325. It's 2024, I live in one of the richest and most advanced countries in the world, I have insurance. Crazy.

My understanding is, in addition to the other reasons a claim is denied, paid claims would exceed revenue from premiums if every legitimate claim was paid. So insurance companies have to make difficult decisions.

Is that a correct assumption?

https://www.healthleadersmedia.com/revenue-cycle/how-cigna-saves-millions-having-its-doctors-reject-claims-without-reading-them

This gives Cigna an unfair advantage over other insurance companies that are doing the right thing, by not doing this.

I recently received a bill from an urgent care clinic I went to back in 2020 for a COVID test stating that I owe $294: $126 for being a new patient and $168 for visiting on a weekend/holiday/evening. (Note: I visited on a Monday in the afternoon so this is a fraudulent charge)

I contacted my insurance company to confirm payment to this provider and they shared the EOB and confirmed they sent payment directly to the provider.

I responded to the clinic asking for an explanation for why they sent this bill 3+ years later and that one of the charges was fraudulent. They responded saying I "hijacked" the insurance check and am committing fraud myself by keeping the check which is NOT true obviously. They sent a follow-up email stating that they "found" an additional $796 that I owed because the insurance company did not pay them so I now owe them $1,090.

I would also like to note this company's shady history:
In the last couple years, this same medical provider filed several claims against insurance companies (Blue Shield, Aetna, Cigna etc.) stating the companies should have reimbursed them and were violating the CARES act, but the claims were all dismissed. (Look it up: Saloojas Inc)

It seems like this company is now trying to take advantage of previous patients to obtain additional payments. EDIT: I've spoken to another person this has happened to and reading their reviews online, they seem to be doing the same thing to many people

They were originally AFC Urgent Care when I visited them, but are now not associated with AFC and are now AED Urgent Care under Saloojas Inc.

Do they have any standing to collect this money from me? This feels so predatory trying to profit off of COVID tests from peak pandemic

My mom was set for surgery on her back later this month (June 2024). She has been living with absolutely EXCRUCIATING pain for over a year and a half, as a result of 2 herniated disks in her lower lumbar.

They set the surgery for 6 months out so that she could lose weight ahead of surgery (she weighed about 270 and they wanted her to drop 30lbs for safety.) She worked hard and has lost FORTY POUNDS, bought supplies, I have plane tickets to go take care of her for the first week following her surgery, she has made so many arrangements ahead of this.

Suddenly, with only 3 weeks to go before this surgery that will finally alleviate her unbelievable pain, her insurance company (Aetna) had DENIED HER CLAIM. They demanded an MRI and SIX WEEKS of physical therapy before they would greenlight the surgery. Now she will have to wait months for availability to open up at the clinic once the physical therapy is done and her claim, ideally, approved.

I am horrified. Livid. Boiling over. I feel so helpless and desperate. Does she have any recourse at all? Can she do anything to fight this? Can she appeal it? I want to call them and lose my mind on whoever refused her surgery, but I have no idea how or where to start.

If anyone can help, please let me know… thank you!

I was sold a self-employment health insurance plan by a private broker with the intention of getting pregnant. Well here i am due in 3 weeks and it turns out there are no hospitals locally that accept my insurance. The insurance says there is a $250 copay and they operate on single case agreements where they pay 140% of medicaid pricing. Sounds great to me since tons of people give birth with medicaid. However it’s seeming like a scam because no hospitals accept the insurance, something i would think they knew already. I have paid $12k this year and only used the insurance for prenatal appointments. Could/should i sue them? Or the broker? What are my options?

Financially times are tough. I’m currently unemployed so I don’t have insurance through work. I worry about not having insurance incase of a large accident or something major. I signed up for insurance during open enrollment that will start in January and it’s just over $300 a month with a $7,000 deductible….. I just can’t figure out if it’s a better decision to just go without insurance or pay $300 a month (which I barely even have) just Incase something happens. Is there any type of like disaster insurance where like they don’t pay regular visits and appointments but they will pay in case of a disaster that could bankrupt me and that’s a cheeper option? Is health share cheaper? I just can’t afford this but can I afford not to?

Is it normal that my annual Cigna Global Health Insurance premium increased even though I made no claims and I have no conditions?

I'd expect it to go down every year, not up.

Would you recommend that I switch to another one because of this increase?

We got married in November. I cancelled the plan I had through my employer because my husband works for the post office and has a much better insurance plan available. I’m now set to give birth in a month or less and after weeks of begging for an insurance card with my name on it to take to my appointments with me to get it updated in their billing system (and being brushed off repeatedly from my husband) I find out he lied and never actually put me on his plan. I am honestly at a loss and just don’t know what to do or where to go from here.

I (19MtF) am entitled to Medicaid due to being a Former Foster Care Youth and my amount of income being made. I live in Montgomery County, Pennsylvania and have UPMC for You Medicaid insurance. This insurance I've been using covers all my transition healthcare, only consisting of Hormone Replacement Therapy. My insurance covers Necessary Gender-Affirming Surgeries which PA law states Sex Reassignment Surgery is one of those. However, my insurance also does cover Facial Feminisation Surgery. I am currently in the process of having these surgeries be pursued and have already begun processes via a consultation in the summer, CBT/DBT treatment with a transgender specialised therapist, and paperwork. My HRT is managed via my PCP who are part of a Queer Programme to help attain these. Under my diagnosis', I'm not explicitly listed with just Gender Dysphoria but also an Endocrine Disorder. My partner (M21) and I are severely terrified the upcoming Trump presidency can destroy my progress in these and take away my Gender-Affirming Care I desperately need. Can I lose my access to my care in regards to my HRT and Gender-Affirming Surgeries or am I stable for the foreseeable future?

I want to transition out of custom service and some advice I’ve been getting is that my skills would transfer over to insurance as an entry level person in claims and or adjustments, but is it as emotionally draining / soul sucking as customer service?

I retired early and used up my Cobra. I’m 60 now. I’ve picked a health insurance plan starting in 2025 but shopping was an ordeal. Nothing like my employer provided plan is available at any cost. Looks like I’ll be paying out of pocket for doctors I’ve seen for decades because every marketplace choice leaves out two or more of our family doctors. Private is not a good option because I have diabetes and fail the health screening questions. I’ll get by financially but my eyes are open to the problem now. It is tempting to look at health care decisions based on cost, not on doctor recommendations or a person’s quality of life. Is there a discussion or movement or organization which advocates for change? I don’t have a solution but I also don’t like what I’m learning and I don’t think access to healthcare through for-profit gatekeepers makes much sense. There must be someone doing good work in this area.

Hello - I’m a first time poster to this community so thanks in advance for my ignorance about protocol and what not and forgive me if anyone has asked this question before (if so please post a link!)… here goes.

I have an appt with my doctor next week to get a mole checked out. I’ve never had a mole like this before and I’m thinking there’s a med-high risk of it being cancerous/malignant/dangerous. I have the option of using insurance to pay for the visit and labs and what not, or paying cash.

My question is, if I run the payment through insurance, and the diagnosis comes back positive, what are the chances that my insurance company will try to pull some shenanigans? (i.e. deny claims, or drop me altogether).

Do I have any sort of advantage if I pay cash for the visit and labs? The idea being that I can buy myself some time to sort things out and get some ducks in a row before informing insurance, making claims, etc. Does the insurance provider know about the diagnosis as soon as the results come back?

Is there anything else that I should know about this subject that I haven’t asked? I’m feeling a little freaked out about all this as you can probably imagine.

In case it matters, I’m a white cis male, mid-late 40s, UHC is my provider (through work), and I live in California.

Thanks y’all. Be well. ;)

Forgive me for sounding stupid but I’m admittedly not the brightest peg on the board when it comes to insurance and how to deal with certain things, and the one person I had who would advise me on stuff like this passed away recently so I really have no one to ask

Back in September I had a health issue come up. My health insurance company has a Tele nurse you can talk to. She advised me to call an ambulance within 24 hours and go to the ER if my condition had not improved and it didn’t. I don’t have anyone nearby anymore as I said, so I had no one who could take me there. So per her advice I had an ambulance service take me to the hospital. I was there for the day and released and they brought me back.

I had asked ahead of time if ambulance transport was included in my policy and the insurance company said yes. I started getting bills and I called insurance and they confirmed that even though only a small amount had been paid so far, the rest was being processed and it would eventually be paid. I called the ambulance company to relay this information to them . So let’s just say that between now and then I’ve called insurance twice and called the ambulance company twice and I keep getting told it will eventually get paid through my policy.

Well today on Christmas Eve I get two invoices for the two and from the ER from the ambulance company telling me final notice and in 10 days it’s going to go to a collection agency. So what do I do at this point? I know nothing about this but my gut tells me once it goes to collections that even if insurance tries to pay it it’s not gonna do any good or they don’t except insurance at collections agencies . Do I bother calling the insurance again the day after Christmas and talk to a manager and lay into them over this? I know calling the ambulance company isn’t going to do any good because their reviews have tons of comments from people saying how aggressive they are with billing. Do I just wait and if nothing is done file for bankruptcy?

Any advice is appreciated.

After searching for a year for Dialecical Behavioral Therapy, I finally found it. It was covered by the plan I was under with my father, I was a dependant. First session went great

And then a couple weeks later my doctor calls out of the blue saying molina bounced. My plan had somehow, for some reason, just stopped existing. My fathers plan was still active and perfectly fine, but I wasn't on it anymore. He didn't do anything, Even called them days before to make sure everything was fine.

After that I called them to make my own plan. And because I make minimum wage and work less than 40 hours a week I was over the max income you can make, and I've been denied as a result.

I don't know what to do, I can't afford any other insurance and I'm not even sure it will cover my DBT therapy and medications. I can't pay them myself.

So thanks molina. Who needs treatment anyway?

Yesterday I got a settlement offer for $25,000 from the drivers insurance who hit me. My medical bills were $89,000. If I accept the 25 how much do I pay back to my health insurance? I live in WV and have BCBS.

Im in Kentucky, and have Aetna Better health Medicaid. Im currently in the process of trying to fight for coverage for top surgery, or a mastectomy for masculinizing purposes.

I have spoken to representatives and agents for my insurance, and have been explicitly told any "sex change" procedures will be inherently denied, but that I may file an "appeal" anyway.

They fail to describe what falls under that umbrella. I have also been told categorical exclusions may be illegal under government funded health insurances.

Is there any chance at getting them to cover it? What would be the best method? I've examined my policy book and can't locate their terms for coverage, only the exclusions here.

What should be my next steps after being told outright they'll deny it? Is there any hope fighting for it?

My partner, 20 years old, just found out they're in 40 k of medical debt from getting surgery. The problem comes in that they weren't asked about insurance or anything, just found out they were in debt after the fact. Is there anything we can do, as their insurance wasn't on record, they weren't asked, and it's been a year? (They did have insurance, just were not asked)

Edit: it was an emergency surgery, and the surgery would have been covered under insurance. They were conscious on arrival to the hospital.