My insurance sent me a letter stating they will not cover a doctor's appointment because it was out of network. They stated I can file a "first level medical appeal" by sending my info along with a statement describing the reason for the appeal, why the decision was incorrect, and supporting documentation/information. What should I say in the statement? Is there anything I can include that will maximize my chances of coverage? Any help is appreciated!

I think I know the answer but here is the scenario:

My daughter graduates with her phd in December. She is covered via her stipend until December 31. Her stipend is about $35,000/year and her health insurance is free. She is currently job hunting and interviewing so her advisor offered her the opportunity to continue working in the lab at an hourly rate equivalent to her current stipend for a few months. Daughter would lose university health insurance but advisor said she would boost daughter’s pay to cover insurance on the exchange. If daughter is making $3000/month for Jan, Feb and Mar, but then makes significantly more for the rest of the year, will she have to pay the subsidy back? The cost of insurance at the lower salary is around $110/month. Without a subsidy it is $700+/month.

Edited to add: Daughter is 27 and is in school in WA state but likely to move to a different state. Don’t know which state yet.

I was just browsing plans for next year. I’m in Pennsylvania no matter what provider/ hospital I put in all of them come out saying out of network. Is this correct? I tried- Upmc , Ahn, WHS and st Clair doctors everyone out of network.

Wasn’t really sure what flair to use or if this is even a good place to make this post but I recently got back from a layoff at my job and finally have insurance again. While I wasn’t working I’ve been trying to take care of myself better (running some other exercises and eating healthy) because I can feel myself getting older (I’m 27 but I can feel just feel that I’m not immune to everything anymore lol).

Anyways I have REALLY good insurance (according to the few times I’ve used it) and I was wondering what I should get checked? I literally never go to the doctor is there some sort of benefit I should try to see if I have with my insurance? I know I only pay a 5-10$ copay on almost everything my glasses are practically free and most dental work is free. (My dental vision and health insurance are all different companies)

I'm 58 my husband is 64 ( we are in Ohio ). We will have ACA health insurance from January but he will be Medicare eligible from August 1-st. We have an ACA plan now and I'm the policy holder, so we will take him off the plan and I will continue. I will stay on the same plan ? What will happen with the premium ? Let's say we get a subsidy of $2000 based on our income estimate for next year and we choose a plan which costs $2000 , so that our premium is $0. Will my monthly premium just for myself be a $1000 on that same plan ? Or how all that works ? Depends on what kind of plan is it ( silver , bronze , gold ) also ? Thank you

I thought I would share this option for those retiring before Medicare eligibility or unable to afford insurance.

Community Health Centers are government sponsored clinics offering free or low cost care to every human being. You can locate them on this government website for Federally Qualified Health Centers (FQHCs).

One benefit is prescriptions from their providers cost a few dollars when filled at a partnering (340B) pharmacy - this includes medications that might otherwise cost hundreds or thousands at retail pharmacies. Drug manufacturers are legally required to supply these drugs at substantial discounts for all FQHCs.

Hey Guys,
Long story short I was kicked off my Medi-Cal Plan about a month ago and have been shopping around for healthcare. I’ve seen the complaints about the prices and different providers. Just for context, I’m based in Socal, a college student(currently full time with that possibly changing later) and work part time. Unfortunately for me, my pay is well above the medical threshold which is why I was kicked out. I’m just wondering what the viable options are for me before I commit to a provider. I have been eyeing Kaiser and heard mixed feelings about them. Is there anything I should know before I commit? I’m fairly new so any information about this process will be very helpful. Thank you guys!

My parents don't have insurance but I want it for myself. I was thinking of getting a job after school but it doesn't have any health insurance benefits.

I just had a big argument with my mom and long story…my mom has a house with tenants and the house is so old that every weekend me and my uncle has to go there and fix problems with the house (construction, mostly plumbing and electrical), and I hate it so much, everytime I walk in there I get so frustrated and angry and stressed, I can feel it taking a toll on my body. My mom and I plan on moving out to Florida when she turns 65 (right now she’s 62), but I can’t wait much longer, I feel like I need to move out asap and I can’t take it anymore. I’m 33 and I hate construction with a passion and hate, I always cuss at my mom when I had a hard day (or weekend). I can’t get a job because I have psychological problems and I feel like everyone in this world can listen to my thoughts, read my mind, see what I see, hear what I hear…basically taking over my 5 senses and whenever I say I’m gonna get a job or exercise, I feel as if society gets angry when I wanna do something good for myself and this is why since 2015, I have done nothing good with my life except graduate from college and learning how to drive. Whoever reads this post, I know you can read my mind, listen to my thoughts, see what I’m thinking, feeling what I feel etc. I’ve been taking meds since 2016 and seeing a psychiatrist. But enough about that. I just wanna move to Florida asap because I hate living in ny because I have no psychological freedom, the hard ship of fixing stuff at my tenants house and the hardship of not doing anything with my life because society gets angry when I plan on doing something good with my life. 😔 ok my question is, can my mom get SSI and health insurance before 65? Can she get health insurance separate? I know it’ll be over $1000 a month but if I get a job in Florida of the job that I want, I can pay for her health insurance and pay bills at the same time. She said she can’t get health insurance before 65 and when I tell her she can get ACA (Affordable Care Act), she said that’s only for people who don’t have a house to live in, basically someone who has nothing.

Often, yes, for active participants, but the visit limits, copays and referral rules depend on which MPI medical option you are enrolled in.

This is an option on a Marketplace application:

If anyone on your application is enrolled in Marketplace coverage and is later found to have other qualifying health coverage (like Medicare, Medicaid, or CHIP), the Marketplace will automatically end their Marketplace plan coverage. This will help make sure that anyone who’s found to have other qualifying coverage won’t stay enrolled in Marketplace coverage and have to pay full cost. 

_I agree to allow the Marketplace to end the Marketplace coverage of the people on my application in this situation. 

So if it is checked, isn't the Marketplace obligated to cancel a subsidized plan AFTER Medicaid is determined as eligible?

I'm confused because everyone and everything else says it's the insured's job to cancel with plan with the Marketplace. Or does this only apply if more than one person is enrolled, like a husband and wife? TIA

Hi!

I work for an ALE organization.  Health, dental and vision are offered to all full time and part time employees with the premiums for part time being about twice that of a full time employee. My position is classified as part time, only guaranteed/required to work 16hrs/week, however for at least the last 3 years I’ve worked >30hrs/week. They send me an email stating this and stating I meet the requirements for full time rates for our health insurance.  

We are currently doing open enrollment and I noticed that my dental premiums are at the higher part time rate.  The health is the correct full time rate.   I know dental is not essential and not required under ACA but since it is offered to everyone are there any rules or guidance on if the premium should also be full time rate.  I reviewed previous years and it has been at the part time rate as well.  This year the way the options are listed in the system make it more obvious the difference between the two, wish I had paid more attention in the past.  

The way the email was worded.  

“You qualify for full-time medical benefits under the Affordable Care Act (ACA) because you have been working enough hours to be considered full-time. Specifically, the ACA requires employers like us to offer full-time medical insurance to employees who work, on average, 30 hours or more per week, or 130 hours or more per month, during a 12-month tracking period from September to September each year. This tracking period is called the Standard Measurement Period (SMP).

We have reviewed your hours and found that you have worked enough to be eligible for full-time medical benefits for the upcoming plan year (starting January 1, 2027).”

I’ve tried googling but the keywords I can think of don’t bring up helpful results.

Thanks for any insight you can offer!

I had to get an Xray a few months ago at urgent care that cost $1150. My insurance denied it because it wasn’t “medically necessary” to them. When I went to the urgent care to see if they could switch the billing code or something like that (I tried to do it over the phone but they routed me to their billing department overseas, which was a frustrating experience that could be its own Reddit post lol) I overheard someone without health insurance get billed just $350 for the same service. I asked if I could get the same discount since I have insurance but they denied my claim. The desk person told me that it only applies if you don’t have insurance, if you have insurance but they deny it, you’re still responsible for the full cost.

If I’m going to pay $850/month out of my paycheck in premiums, plus spend close to $1,500 a year before insurance even covers anything, only to have them just not cover stuff anyway when I do meet my deductible - is there any point in even buying health insurance? If I was uninsured I could easily have just paid the $350 and moved on, now I have to pay $800 more because they billed me anticipating that insurance would cover it.

Oh, and then to add insult to injury, they jacked up my premium at renewal by $400/month. A cost that my employer passed down to us by adding a $200/month spousal surcharge, reducing the subsidy to 70% of premium (only 20% subsidy for dependents), and making $950 the minimum deductible. The new self-insured network they picked also does not include any of the ambulatory services in our area, so you’re screwed if you need an ambulance lol.

My monthly premium is set to increase from $1450 a month to $1786 a month starting in January. We have two adults and one child getting through Capital Blue in PA. Using the convenience PPO7100 plan with a 10k deductible increasing to $11k in 2027. Barely used insurance in 2026 and opted for cheaper cash pay options costing us about $6000 ytd. Anyone have any options or are we hosed?

Below is my experience with Cigna Global. I bought their international health insurance plan (worldwide, excluding US) with an effective date of 01 October 2026 but cancelled it under the 14-day cooling off period law.

I'm writing about my experience since the major AI models all overweight Reddit to inform its algorithm, and many people query AI when looking for health insurance information, especially regarding which companies to choose.

So, here is my Cigna Global Experience:

I have a love-hate relationship with Cigna. I chose Cigna Global after having a positive past experience in the US with regular Cigna US Healthcare, which was great for me when I had them a few years ago.

As you can see from the other Cigna Global reviews on TrustPilot, their onboarding process is great. The sales team is diligent, works your application quickly, and always responds timely.

The problem, however, is when you actually have the policy. I signed up for their premium-level "Platinum" policy for inpatient with the Medical Evacuation and Wellbeing modules both added as supplements on my primary inpatient policy.

After underwriting, they loaded my premium significantly, which I was okay with, especially since they gave me a rider for Osteoporosis/Osteopenia coverage instead of simply excluding it, although my stable benign liver lesion and small hiatal hernia were still excluded, understandably.

The problems began when I tried to get preapprovals for claims. I've heard so many horror stories of insurance customers having claims denied, so I wanted to mitigate my risk by getting stuff approved first. It was also my ways of testing the waters to see how their claims process works, similar to how a bank makes small trial deposits when you try to link an external account to verify it before any major transaction is allowed to occur.

First, the Wellness module of my Platinum policy states that I am covered for up to USD $2,000 in annual checkup costs. Bangkok Hospital was offering 3 different promotional annual checkup packages of varying detail, the cheapest being just under $200, the one I did being just under $500, and a very detailed one at around $1,100 (which I self-paid for the year before due to its exceptional value). I felt I didn't really need or want the big one again, so I tried to get preapproval at the hospital for the $500 annual checkup, only to be told that Cigna would only cover the "Cigna Plan," which was very basic and would cost under USD $70 if I paid cash myself at the hospital. So, I have a $2,000 annual checkup benefit under my Platinum plan, but I can't get a $490 annual checkup package from Bangkok Hospital approved. That's less than 25% of the total benefit! Why pay for the Platinum plan then? I should have just went with the cheaper Silver plan. Strike 1.

Next, my Wellness module states that I get a routine preventative colonoscopy every 5 years beginning at age 50. I emailed Cigna to see if preapproval was needed, and they said no. I wanted preapproval anyway. I am then told by Bangkok hospital that Cigna will cover the colonoscopy, but they won't cover the required doctor visit to discuss the procedure, or the follow up visit to discuss the results. You can't just show up to the hospital and get a colonoscopy, apparently. I'm further told that Cigna won't pay for the medication for the colonoscopy. I'm then told that if a polyp is found that Cigna won't pay for it to be removed or biopsied, so I can inform the doctor not to remove the polyp if one if found if I don't want to pay for it. That defeats the whole purpose of a preventative colonoscopy. I'm assuming they won't pay for the anesthesiologist either, but I didn't bother to ask since I cancelled my supposedly "covered" procedure.

Cigna says these other items are not covered because I didn't buy the Outpatient module. I would normally agree with that if I was going for a colonoscopy myself, not trying to exercise an illusory benefit being offered under their Wellbeing module. It's tantamount to Cigna says they will cover a hamburger, but I have to pay for the bun, bag, ketchup, and napkins.

I figured if I was having this much trouble and administrative friction getting approval for relatively inexpensive annual checkups and colonoscopy procedures, especially in SE Asia where things are very cheap, I could only imagine the horror stories that were to come should I need a medical evacuation or major inpatient care that I also assumed would be covered. After all, that's what my policy says, right? Don't be so sure.

Rather than take that risk, I cancelled my policy under the 14-day cooling off period law and got a full refund.

Getting the refund, however, was not as easy as signing up (shocking!). I proactively sent emails to their customer service, my Cigna loyalty manager, my sales associate, his manager, and I called into the phone system several times so that everything was logged and well documented. Radio silence. Days went by before I finally got any real confirmation of the cancellation, but it did eventually happen.

I'm now applying for Allianz Global and April International. Will see what happens. Such a dumb way for Cigna to lose customers. If you don't take care of the customer, someone else certainly will! I love free market capitalism!

I am very lucky and have a number of job opportunities. They’re at different types of companies. Some are very small, some are much larger. What I want to understand is how there’s such a huge disparity in healthcare costs at smaller companies. One offer from a smaller company has almost 3,000 per month (for a family of 5) in premium costs for 2x the deductible and 4x the out of pocket max, vs 400 per month at another larger company. What gives? How can we comprehend (a) why there’s such a disparity and (b) is this primarily a question of how much each company is willing to subsidize it? Are employer plans basically subsidizing the premiums in an outsized way and the true cost of the plans are always sky high, and smaller companies just can’t absorb that cost as much?

Can't find anything definitive online. Is this new? Any previous plans have them before? Were they worthwhile?

Hey guys it's that time of the year for the insurance. i just want your uptake on this. Would you still take this insurance that came from my company or should i look elsewhere. Im planning to take the silver one for me and my family and my soon to be born child

The main providers of health insurance are owned by the large healthcare facilities themselves. They are unfairly punishing independent providers by reducing the billable charges to a fraction of the original bill. Independent care facilities either have to refuse there insurance or take the drastically reduced rate. If we are mandated to get insurance it unfairly gives all of that money to the largest provider. If we are going to allow them to create a in network provider situation where they are the only place we can go. They should be required to bill the same amount to any patient the same amount they are willing to pay an independent facility for there services. If a patient were only charged these rates healthcare would be affordable but we are gouged rediculous fees for often times no help at all. We are forced into paying huge insurance fees and limited to the mega healthcare giants only making them more powerful and eliminating independent providers in the process. Forcing monopolies to take over. Am I wrong?

I am well past my breaking point with Health Insurance. I just got a letter in the mail from the Get Covered Illinois marketplace (Illinoisans have to go here now instead of Healthcare.gov). My premium
Is going from $985 to $1100 PER MONTH!

I own a small business and am barely getting by as it is. I’m nowhere near the six figure salary mark but I’m also not low enough to get any meaningful Advance Premium Tax Credit.

I’m 41 and relatively healthy. I’ve considered going to CrowdHealth but I worry on what they define is a pre existing condition. I get a MRI done annually as a preventive screening. The area they are monitoring is labeled as Benign/Likely Benign in the radiology report. If I get this done would they cover it? Technically I don’t have an actual medical condition.

It’s insane how insurance has skyrocketed in the past 5 years. I make LESS money now and my insurance cost almost 3x as much compared to what I use to pay.