Hi! I’m looking for any advice I can get. Long story short, my husband’s school is closing. He received a message TODAY that his school is dissolving and benefits end TOMORROW. His plan goes September to September so we had one month left, so we thought. We are in Pennsylvania.

Problem is, we are due in two weeks, around mid-August. He immediately went into panic mode and contacted HR to see if COBRA would be offered because we already met our deductible. Their healthcare plan is in partnership with a sister school so the plan will stay active even if this school dissolved. No response from HR at all.

We are considering a Pennie marketplace plan but as I understand, we’d have to enroll tomorrow to have coverage August 1.

If we don’t hear from HR by the morning about COBRA, should we just buy the marketplace plan tomorrow?

I have no idea what to do and I’m panicking so any advice appreciated! Thank you!

In 2023 my wife and I were expecting a baby with an anticipated due date of 12/31/23. With the due date so close to the end of the year we feared we would run into insurance issues with our deductible resetting 1/1/24. We planned ahead and made many phone calls to both the hospital’s billing department and our insurance provider to discuss the possibility of being admitted to the hospital in the year 2023 and having our stay extend into 2024. I was told by a United Healthcare representative that as long as we are admitted in 2023, even if our stay extended into January of 2024 it would all be covered under a continuation of care from our initial service date.

Fast forward we decided to induce on 12/31/23 as our daughter hadn’t arrived on her own yet. My life labored for hours and around midnight the doctors decided she would need a c-section. She ended up having the surgery at 1 AM. We ended up having to pay for our daughter’s care because she was technically born in 2024 but we never saw a bill for any of my wife’s care as we had hit our deductible and assumed all of her care was covered as we were assured of by our previous calls to UH.

Fast forward again to this week, March 2025, and we just received a bill in the mail for $2,700 for her c-section surgery. From the EOB we got it appears that United Healthcare denied all of my wife’s care from midnight on New Years to the remainder of her hospital stay, completely back-tracking on their previous assurances we would still be covered from 2023. To complicate matters further, my wife and child switched to a Blue Cross insurance plan for her and our daughter for 2024 and the hospital decided to just bill the items that United Healthcare denied to Blue Cross instead and never told us of the situation. Now we have this bill that should have been covered by United Healthcare which has been partially covered by Blue Cross who should never have been billed for.

The hospital is taking no ownership of the matter and is telling us we have to take it up with United Healthcare. We talked with UH and they said I need to provide dates and times that I had these conversations with their representative and file an appeal. With those conversations having been had over a year and a half ago I don’t have that information. We filed an appeal but from UH’s website it says no appeals can be made after a year from the time of initial denial but we weren’t even made aware that the claims were denied until 15 months later.

We are at a loss for what to do and I’m wondering if I need to get an attorney involved. Any insight is appreciated.

Edit: Lots of people are assuming I purposely neglected to inform the UH rep that my wife and child would be switching to her employer’s health insurance at the start of the new year and mislead them. That is not the case, at the time I spoke with them I did not know what our insurance situation was going to be at the start of the new year as our employers had not released their plan information for 2024 yet at the time of inquiry. A clear oversight on my part to not think about that aspect when trying to plan ahead an I own that miscalculation and am not blaming UH if that is the ultimate reason they are denying that claim. I just assumed everything would be covered as they said and didn’t take that aspect into consideration which may be our downfall.

Edit 2: The hospital reached back out to us and determined that they are deleting the invoice and zeroing out our balance. They didn’t explain exactly why they are doing so but it seems like they dug into this further and determined that given the amount of time that has passed without notifying us of any insurance billing issues they are going to delete the bill and not pursue any further charges.

So I’m 6m pregnant with mono di twins and I am over working so I resigned. My job is stressful and demanding especially now that we are understaffed. After talking with our insurance company about COBRA I felt good about resigning and just relying on that. My husband is a contract worker so our healthcare is through my employer.

I didn’t think the COBRA would be that much more expensive but I’ve seen people talking about $700/month. I haven’t gotten a quote from my HR rep yet but I’m feeling anxious about my decision now. Should I rescind my resignation and keep working? Or should I ask my OB for FMLA paperwork if that’s even appropriate? Help 🫠

Edit:di not do

I recently got married and was looking to add my wife to a health insurance plan as she just aged out of her parents at age 26. My company informed me that they do not cover spouses and if I wanted to add her to my plan I would have to pay in full. They told me that my plan would remain at $56 a week and hers would be $164 a week so $872 monthly on health insurance which seems extremely steep to me. I’m wondering if this is the norm or overpriced when adding a spouse to a plan.I am 26 and live in the state of Indiana I make slightly above $60,000 a year

My husband has been having back pain for several years. He finally decided to see a doctor about it. We were told to see the doctor he had to do 6 weeks of physical therapy. Our deductible is 10,000 dollars. So the 6 PT visits were $1,000 dollars out of pocket. Then we were told the next step before he could see a doctor was an MRI. So he went to the recommended office and got a typical Spine MRI. When we received the bill the cost was $5,000 dollars! So now we’re at $6,000 total out of pocket and my husband’s back is no better. We live in New York State. My question is do we have to pay the $5,000 bill?? We’ve ran numbers at other local MRI places and the cost was never over 2,000. We researched the fair market value of an MRI, again never over $2,000. We called the MRI center and showed them our research, asked for a cash price, and asked for itemized bill to look for mistakes but they refused to come down on the price. We tried a third party advocate (goodbill) and the hospital refused to come down in cost for them. So my question is what else can we do? I would have no problem paying what an MRI should actually cost. Which according to my research is no higher than $2,500 dollars. But I can’t seeing draining my savings to pay for a bill that feels so absurdly high. What would happen if we just didn’t pay it? If we went to court would we have a leg to stand on because the price is no where near “fair market value”? All this and my husband’s back is still the same. Thanks for your time and consideration.

I feel like I’m living in a Kafka novel.

I was laid off in November, but my employer changed my official exit date to a few weeks later. I enrolled in COBRA immediately, and they told me, “No rush — you still have coverage through December, and COBRA will kick in starting January.” Come January, I called to confirm, and was told it would take a few weeks to process, but “Don’t worry, your insurance will be backdated. You’re covered.”

Well, I kept calling — especially right before my delivery — expressing how uncomfortable I was giving birth without having an actual insurance card or confirmation. They kept reassuring me, saying it was just a tech issue with systems not syncing, but that I'd be fine.

Spoiler: I was not fine.

I gave birth. Everything went well medically… until the $17,000 hospital bill showed up.

Turns out, my former employer made a small change to the coverage plan starting in January — just enough to make my hospital "out-of-network." But because the COBRA enrollment was delayed (and backdated), neither I nor the hospital could verify this in time. The hospital says it's not their fault (which I agree with), the insurance company blames WEX (who processes COBRA), and WEX says they don’t handle billing and can’t help.

So now I’m stuck, jobless, with a $17,000 bill for what was supposed to be routine, in-network childbirth. Everyone involved is pointing fingers, and no one is taking responsibility.

Has anyone been through something like this? Is there any recourse? Appeals? Legal advice? Debt forgiveness paths? Anything?

I’m feeling really overwhelmed and desperate right now.

My partner works at a small business that’s scaled up recently and began offering healthcare plans. She signed up for a plan without really thinking about or talking with me about the ramifications of it. Now we have onerous $800 monthly healthcare plan payments that have made our living situation unsustainable. We tried talking to the HR representative at her workplace who said we cannot get out of the plan unless we have a “qualifying life event”.

We cannot afford or live with these payments, what can be done to reduce the amount?

Looking for any advice/support.

My significant other is on my insurance plan through my employer, Anthem BCBS.

She has rare autoimmune disorder, Myasthenia Gravis, that has been somewhat well managed by a medication called Zilbrysq. These are daily injections.

She has tried other treatment options over the past few years which were all infusions, but Zilbrysq has been working the best. I judge this based on the fact that she has had fewer ER visits for respiratory weakness.

My insurance just picked up as her primary pharmacy coverage, and they denied coverage of the medication. At this point, the claim has been sent to a 3rd party for review.

She was able to get a 14-day emergency shipment from the specialty pharmacy, but I have been seeing that appeals can take 30-60 days to hear back from.

We are extremely concerned that this is going to drag out and result in her hospitalization/ intubation as she declines pretty rapidly without medication.

Her prior health insurance had been covering the medication, but its running out due to her being on long- term disability for quite some time.

We've tried calling BCBS, but they have been quite unhelpful and simply tell us in general terms why the medication was denied.

Is there anything we can do to expedite the process of appealing? Can they really just deny a medication that has been effective in managing her condition?

Thanks in advance for any information. This has been a massive headache and I feel utterly helpless. I don't want her to suffer unnecessarily because of these delays

EDIT: Thank you, everyone, for your support and input. It's been very empowering to learn from what you all have had to share.

I didn't end up having a break at work yesterday to call the insurance, but I was able to today. After an hour on the phone, I was told they would call me back with an update as to what the status of the current appeal is. It sounded like the appeal was in the expedited status based on what the representative shared, but they didn't seem to have all the info.

To clarify, I am posting this in an attempt to help my domestic partner. I don't have all the answers, and I don't have a direct line of contact with her provider. However, I know they are both working diligently to find a solution.

I've received a letter of denial in the mail stating that the medication may be approved if they can see "documentation of at least a 2-point reduction in Myasthenia Gravis Activities of Daily Living [MG-ADL] total score from baseline."

I've been assured from my significant other that the provider has sent this documentation.

My husband's job lapsed paying on health insurance since April of this year. He pays for part of it out of his paycheck for our family, and they cover his part. They reimbursed him for three months worth of his premiums when they admitted he didn't have health insurance, after he wasn't able to pick up a prescription at the pharmacy due to no coverage that was very expensive. I had a colonoscopy at the beginning of May, because of the problems my husband had previously had the week before with insurance, I had him go to the insurance/benefits person at work and ask specifically if we did in fact have insurance. He said my wife has an appointment for a $5000 colonoscopy that we need to make sure is going to be covered and they said "yes, you are both insured".

I just got a $5176 bill for the colonoscopy due to no coverage. Where do I go from here? Can I start shopping for health insurance or do I have to wait now until the enrollment period? Is this legal? How to proceed?

Edit: none of the 5 employees have insurance currently

I had a free consultation with a doctor to discuss treatment plans he offers. Everything sounded good, so I agreed to give him my insurance information. Then I find out that he billed $2400 to my insurance for my “free consultation”. I believe this to be a fraudulent charge.

What do I do? Can I get my insurance company to fight the charge?

I have employer sponsored insurance with a $3400 deductible and $7200 OOP Max. Last Thursday I miscarried at 11 weeks and need to go to the ER due to severe hemorrhage. They took blood, pelvic exam, ultrasound and nothing further. They wanted to give me a bag of blood but I denied. The billed $7k to insurance but adjusted rate is $3k (not including professional service from attending physician). I called the hospital to see if they would reduce the cost (nonprofit) and they cannot and I don't meet income threshold for financial aid. How can I get this bill reduced? Having my first baby cost a lost less than having a dead baby with the ER not assisting in anything. I'm already emotionally defeated and this took me to a new level.

EDIT TO ADD Thank you all for your suggestions and advice, I have a few routes I will be taking now! Also, thank you for your kindness during this time, it means a lot. Losing a child (born or unborn) is hard enough, add on the financial stress makes it worse.

I have insurance through my husband's employer. I need an in-hospital biopsy done (I will be at the hospital for 6 hours max), and I have the procedure scheduled. I just got a call that my out-of-pocket is $3,350. She was like how would you like to pay today. So casually, it is as if paying this amount out of the blue is a normal daily thing. I got upset at her, saying that I needed to discuss it with my husband first. It makes me so mad to have insurance and still pay thousands of dollars. Is this typical? As someone who has never had surgery and has only gone into a hospital a total of 3 times in my life for other people, I am shocked.

I got married and im not longer on my father's insurance, but I just learned that for me and my spouse to get insurance it would cost me $700 dollars a month, it's almost like a second mortgage and I can't wrap my head around be able to afford it, nothing on the marketplace is really any better unless im fine with the deductible doubling, is this really how much health insurance costs?

EDIT: clarifying my husband and I are recently married, he hasn't gotten a job yet because he is from another state

I am turning 26 next week and will lose my health insurance come the end of April, as I will no longer be allowed to be on my parent's plan without paying a hefty price. My problem is that I have many chronic health conditions that require many medications, many without an available generic. These medications are costly because there is no generic, but they are the only medications that have worked for treating the condition. I have tried all the "cheaper" options and have failed them. The medications I am on right now are the only things that work for me. They've all been covered pretty cheaply through my parent's insurance (about $150/month).

The problem is any health plan that my employer provides only covers 4 of my 12 medications. The others are not covered at all, and paying out of pocket for the others will total well over $4,000 every month. I checked out the marketplace for my state, and they hardly cover what I need them to cover, so it would be just as expensive.

I can stay on my parent's health insurance plan, but it will cost my nearly 80% of my monthly income every month, leaving me with no money to even use the damn health insurance, let alone get my medications. I already work 2 jobs and work 45-50 hours a week, but I just cannot afford to stay on my parent's health insurance. If I do stay on their insurance and pay for it, I'd have to give up my car as I'd have no gas money or money for car insurance, leaving me with the issue of how do I even get to work then. I am literally screwed here and have no clue on what to do. I feel like I am going to have to put my life at risk by stopping life-saving medications just to have money to even get to work to make money to pay for the insurance I can't even afford to use. How is this life sustainable!?

Also want to add, I have looked at online coupons (GoodRx, etc.) for my medications but the ones without generics are still between $500-$2,000 for a one month supply! I cannot afford that every month! Also spoke to my doctors and they do not provide samples forever, only samples long enough until the insurance approves a PA to get the medication approved. None of the insurances through my employer or marketplace want a PA for the medications not covered, they are just not even on the formulary and most say they will make no exceptions to the formulary.

Can anyone offer any suggestions or help here because I literally do not know what to do?

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Hey all, pregnant woman over here dealing with an Aetna denial. Fun times. They denied my fetal anatomy ultrasound (CPT 76811) as experimental / investigational because I have a routine pregnancy (no suspected genetic abnormalities). My hospital, and many others, consider the fetal anatomy scan part of routine prenatal care. Every pregnant person I know has gotten one, and in fact it’s considered THE ultrasound because you get to see their entire anatomy and it’s really exciting. I thought nothing of it until the denial.

Aetna does not consider this scan medically necessary unless there are suspected abnormalities (https://www.aetna.com/cpb/medical/data/100_199/0199.html Ultrasound for Pregnancy - Medical Clinical Policy Bulletins | Aetna). I looked at my medical records and it seems like my hospital coded it correctly, but now what? It’s around $3K patient responsibility. Should I try to convince my hospital’s billing department to recode the claim to reflect a more basic fetal anatomy ultrasound (CPT 76805)? Going in to the scan, I knew it would be a routine anatomy check, again, since I don’t have suspected abnormalities. Any advice or guidance would be much appreciated, thank you!

In the US-Age 28-CT-$60,000

I’m a teacher. I have a high deductible plan- $2500/$4500 OOP max. I’m confused what this all means. I’ve had the same insurance through my parents (also teachers) but I never understood what these things meant. I thought if you met the deductible it would pay for everything? Sorry for my ignorance, I truly don’t understand.

I work for a religious organization that employees more than 50 full time employees - they are considering leaving our current HSA for a Christian Health Share Ministry with an HRA.

Will doing this break the requirement set by the ACA? Or are they exempt from the ACA requirement?

I recently got married and reported this to my employer as a qualifying life event in order to change my health insurance and add my spouse. However, my employer responded that I could NOT change my plan, only add my spouse to my current selections. Is this legal under the Affordable Care Act? My understanding of qualifying life events under the ACA was that you had 30 days with an employer health plan in order to make ANY changes to your health insurance selections. From this, it doesn't seem like my employer should be able to dictate what I can change and what I can't. Of course a life event like getting married may change not just who is covered, but what coverage you need, right? Is there any recourse I can take? The current plan I have just does not work for what we both need, and the next enrollment period is next July. We would be stuck with this for almost a year.

I'm 37 and in Pennsylvania.

It’s over $1,000 a month to use my employer insurance with cobra. WHY? That’s ridiculous. And straight robbery. Just abolish the law if it’s that expensive. I live in PA and the insurance is Capital blue cross basic medical insurance.

I recently got a job with full benefits and this is my first time having health insurance from my employer. I have 1 child so I pay almost $500 a month for health insurance for my child and I. Gross salary is 50k so 4k a month but my net monthly pay is 3k after taxes, insurance, deductions, etc. I recently took my child to urgent care since she was sick. I was in and out within an hour and all they did was a respiratory test panel. She was positive for a respiratory virus so we didn’t get any prescriptions for anything. The urgent care visit was 4k total and I’m responsible for 1.4k of it which is almost the same as my bi weekly paycheck which is insane…. I am literally paying 1.4k for me to know she’s positive for a virus which nothing can be done for. How do people afford this?! Having private health insurance even though my employer is mostly sponsoring it, is making me go broke!

I’m have Aetna insurance through employer , went to quest for blood work and drug screen and they told me I would only pay up this amount which was the original $100 and I figured I was good, now I’m getting a bill from quest saying I owe them $312? Idk how to start this fight but I know someone is lying to me

My wife’s entire department got laid off just one week before her due date. We were both on her BCBS Massachusetts health insurance through her job — $0 payments during pregnancy and a $0 balance on a $6k deductible.

Her employer offered to subsidize COBRA for 3 months, so we thought it made sense to keep BCBS for a little while. My company has United Healthcare (UHC), but after reading stories about denied claims and poor “continuity of care,” we decided to stay on BCBS for her delivery and recovery. Honestly had too many things on our mind then.

The plan was: keep her on BCBS for 3 months, I’d enroll myself in UHC now, and later move her and the baby to my plan once BCBS processed all bills. My employer was OK with this approach.

Fast forward to today — we just got hit with unexpected $6,000 bill from BCBS. Turns out there was a fine print we missed: postnatal care is subject to the deductible.

Since COBRA will expire in 2 months anyway, I’m wondering if I should just switch my wife and baby to UHC now backdated to baby’s birth date. UHC has a similar deductible, so at least the $6k would count toward the rest of the year instead of paying BCBS for just 2 more months.

The problem? When I asked both BCBS and UHC about overlapping coverage, each said their plan would be “primary” — which makes no sense and makes me worry we could end up with an even bigger bill.

Why is health insurance so unnecessarily complicated?

Has anyone encountered an "employer sponsored health plan" so astronomically expensive? This is ridiculous!!! This is in the US for a family plan (my family is 3 total humans, though the plan cost is the same for any amount of humans in the family).

These are PER PAY PERIOD (every two weeks) costs:

PPO plan:

Employee: $589.17 per pay period Employer: $714.55 per pay period

PPO plan Total annual cost for employee before deductible: $15318.42 Total plan cost (employee plus employer) before deductible (premium only): $33896.72

High Deductible Plan ($8000 family deductible then 80/20 coinsurance): $12849.72

Employee:$494.22 per pay period Employer: $599.34 per pay period

Employee annual cost (premium only): Total plan cost (employee plus employer) before deductible (premium only): $28432.56 per year

Title pretty much says it. My insurance denied my IUD. My doctor submitted an appeal which they quickly denied again. My insurance is unfortunately grandfathered in so they’re not required to cover it. Planned Parenthood told me they lost their funding so it still costs a couple thousand out of pocket from them. What can I do next? Is it just hopeless? I’m beyond frustrated because the IUD is the only contraceptive method that controls my painful heavy cycles, I’m suffering every month over here.

We’re (35F/35M) both on his insurance because it has better coverage. We desperately need that coverage to continue this year as we have ongoing medical needs. Paying cobra every month would be much cheaper than paying our medical costs out of pocket. We’re located in New Jersey if that helps.

How long can we stay on cobra if he loses his job?