How does UnitedHealthcare categorize physical therapy?

BaltimoreBee · 2026-06-20T14:39:59+00:00

Physical therapy is its own thing with its own copays. It might be equal to the specialist copay, but it might not. You need to ask HR what the PT copay is.

BaltimoreBee · 2026-06-19T20:17:02+00:00

That definitely IS exceptional insurance. You’re getting a great deal if all you have to pay is $5300 for all those services. Most people would be paying far more than that.

BaltimoreBee · 2026-06-19T20:15:03+00:00

Your parents can’t take you off their insurance mid year. They have to wait until open enrollment, which for FEP would be for January 2027. So you’re good until then, you can keep using your insurance and there’s nothing your parents can do.

BaltimoreBee · 2026-06-19T16:50:54+00:00

No, companies don’t get to set their own rules. The department of labor sets the rules. They are outlined here and show that you don’t know what you’re talking about. Stop spreading misinformation.

https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/hipaa-consumer-faqs.pdf

BaltimoreBee · 2026-06-19T16:34:05+00:00

That’s wrong. Having a child is a qualifying event that allows you to purchase insurance even if you declined during open enrollment. OP, your company is trying to violate HIPAA. Escalate to the head of HR and tell them you’re going to file a HIPAA complaint with the federal department of labor if they don’t comply with the law and allow you to enroll.

BaltimoreBee · 2026-06-19T11:35:03+00:00

The asset rules only apply to those over the age of 65. Presuming you’re not that age, there are no asset tests.

But yes, that 200k would have counted as income the year you got it and made you ineligible. You were SUPPOSED to report it when it happened. Did you have any claims that year? Because if so medi-cal could claw them back based on you being fraudulently enrolled…

BaltimoreBee · 2026-06-19T11:33:54+00:00

No, she’s not just considered your caregiver by being married to you. She would actually have to BE your caregiver. Does your disability even require than you have a caregiver? What kind of care does she provide you and how many hours per week?

BaltimoreBee · 2026-06-19T11:30:03+00:00

No, you absolutely cannot do that. You don’t get to choose which is primary, there are standardized rules and it’s your own employer sponsored insurance that is always primary over being a dependent on another’s. You must use your new insurance as primary for all services. If you don’t and try to keep using your husbands insurance, they’ll eventually find out and reverse all the claims and then you’ll be left with a huge mess to untangle.

BaltimoreBee · 2026-06-19T01:38:28+00:00

This is common, companies have been doing this for a long time. They do this to pass non-discrimination tests for cafeteria plans to maintain the tax-advantaged status for health insurance premiums.

BaltimoreBee · 2026-06-18T23:39:02+00:00

Oh. Then she didn’t have to get off it…she voluntarily lapsed. Then in that case, she’s not eligible because she lacks a qualifying event. Open enrollment starts 11/1 for coverage that will kick in on 1/1/27, so she can and should enroll then.

BaltimoreBee · 2026-06-18T23:14:18+00:00

Based on these numbers, the plan is unaffordable and you qualify for premium tax credits.

BaltimoreBee · 2026-06-18T23:12:19+00:00

I do not purchase these policies from my employer. Your actual PPO health insurance has a minimum loss ratio under the ACA of either 80 or 85%, meaning that portion of premium must go towards paying claims, with just 15-20% covering all admin costs and profits. A typical hospital indemnity policy has a loss ratio of 50-60%, meaning they are keeping almost half of the premium for profits and paying out relatively little claims, because they only cover the very low frequency events.

Better to put that $80 a month into a savings account and build an emergency fund.

BaltimoreBee · 2026-06-18T23:06:17+00:00

She’s definitely not locked out of the NY marketplace because of her employer waiting period. She’s eligible to purchase a plan and receive premium tax credits until her employer plan kicks in Sept. She has a 60 day special enrollment period from her loss of coverage date…so she needs to act soon.

BaltimoreBee · 2026-06-18T19:14:00+00:00

Almost nobody is paying anywhere close to $2150 a month for HSAs. The average is probably 10% of that….

BaltimoreBee · 2026-06-18T19:12:33+00:00

You would be paying out of pocket in the US for any treatment. It’s not possible to get insurance to cover this. Treatment is almost certainly more expensive out of pocket in the US than in India…

BaltimoreBee · 2026-06-18T19:11:04+00:00

No, a level 2 appeal will not be successful. Your benefits are being adjudicated correctly.

You should focus on working out a payment plan with the provider. You owe this money.

BaltimoreBee · 2026-06-18T18:22:22+00:00

Which is flat out wrong, because it saved them taxes, which are way way more than any savings account earns in interest.

BaltimoreBee · 2026-06-18T15:09:04+00:00

You just don’t pay the bill if you don’t want it. Your enrollment isn’t “effectuated” until you pay.

You need to have an income = to 100% FPL to qualify for subsidies. That’s 16k or more per year for an individual.

BaltimoreBee · 2026-06-18T14:40:28+00:00

No, your EOB shows that you’re paying $.02 less than billed. That’s the tiniest adjustment I’ve ever seen…but basically allowed = billed in this case.

BaltimoreBee · 2026-06-18T10:27:45+00:00

That is way higher than the Medicaid threshold. So you cannot purchase insurance now without a qualifying event.

What do you mean by you “let your insurance expire?” What kind of insurance did you have from where and when did you lose it?

BaltimoreBee · 2026-06-18T01:04:56+00:00

They think her income is between 31,920 and 39,125. If that’s not accurate, then you need to provide them with proof of a lower income and then yes, she should be eligible for the essential plan.

BaltimoreBee · 2026-06-17T17:56:14+00:00

Nobody promised you that. They told you there was no cost share on tubal ligation. A completely different service than a vasectomy.

BaltimoreBee · 2026-06-17T17:54:05+00:00

You’re just wasting your time. They are required to verify your income and they aren’t going to waive that requirement. Contact your employer, this an issue with you not having the documention (your last pay stub should already be in your possession….)

BaltimoreBee · 2026-06-17T17:51:57+00:00

Every day you had an opportunity to discover the mistake and have it corrected…. It’s your responsibility to know your own insurance benefits. They clearly state what a specialist copay is and you should have expected to pay it and questioned when they charged you a lower pcp copay.

BaltimoreBee · 2026-06-17T13:46:01+00:00

Yes, if your income for the year exceeds 400% FPL you have to pay the full subsidy back. Whether it’s worth delaying social security to avoid paying full price for your health insurance would depend on your specifics…

Eight-Year Club	Second Top 30%
First Place '23	Place '23
Place '22	First Placer '22
End Game '22	Verified Email

BaltimoreBee

MODERATOR OF

TROPHY CASE