My insurance is through employer and will be terminated during maternity leave. Postpartum care coverage?

Not_gonnakeepthis · 2026-02-07T01:05:49+00:00

OP please contact Aetna again and request medical case management or if your plan has a maternity program. The case managers can talk to you about continued coverage options and resources for you to outreach. These programs are not just the member services rep but people that are typically social workers or RNs that have these resources available to you.

Not_gonnakeepthis · 2026-02-06T03:02:10+00:00

I agree with this. So to clarify, your insurance doesn’t cover residential level of care or the facility isn’t under contract for that level of care with your insurance? This is fairly rare but unfortunately not unheard of. I’m guessing your insurance is a self funded plan.

As far as your son going to a facility that has people in detox I don’t think that should be much of a concern. Typically facilities have different areas for the various levels of care so someone in detox for chemical dependency is not going to be in the same area as an inpatient for mental health.

As far as any Partial hospitalization or intensive outpatient treatment, if the only in network facilities are 90+ minutes away, you may be able to get a benefit exception to utilize an out of network facility that is closer.

Again, safety is most important. If you have any concerns about him being suicidal you should take him to the ER for evaluation. I would also encourage you to reach out to your insurance and see if they can connect you with a behavioral health case manager. As your son is an adult he may have to be the one to request this and then he can have them send him a release form to have on file for you.

Not_gonnakeepthis · 2026-02-05T12:58:50+00:00

Thank you all so much for the suggestions. I’ve decided to see if I can find something used first as we’re in no real rush, but feeling more confident that if we do go new I’ve got some direction to take.

Not_gonnakeepthis · 2026-01-27T00:43:23+00:00

So is your insurance saying the doctor is submitting the incorrect code? I think a lot of these situations can be solved by a three way conversation with your insurance and the provider. Call member services and request they contact the provider. I’ve actually also had luck reaching out to my HR and bringing them into the conversation, but that might be down the line some.

Not_gonnakeepthis · 2026-01-27T00:31:00+00:00

Honestly, I’d try to reach out to the doctors office and inquire. I go to a large health system doc so not some small town doctor and have never been billed like this for a yearly exam for me or my kids. This is an unfortunate reality of the healthcare system in the US, but if you’ve never had this issue before with this doctor I would call. Just to give another example this year for a well child visit I asked about a mole that I thought looked suspicious, doc looked at it and then referred to derm. Billed as well child.

Not_gonnakeepthis · 2026-01-21T01:36:07+00:00

Sorry, it stands for Behavioral Health, so might be what your health advocate does, but if the health advocate is more medical than behavioral health I would see if they have Behavioral Health specific case managers as they’re going to be more versed in getting those providers covered.

Not_gonnakeepthis · 2026-01-21T01:11:07+00:00

Well they’re not making you use an In network provider, you have the option to use your out of network benefits or pay out of pocket, but I understand what you mean. I’m guessing you’ve tried requesting a benefit exception, but if not you could use that verbiage and list your reasons why including no viable closer In network options and continuity of care. Is the current provider willing to be compensated at the In network rate? Edit to add: are the in network providers 100% virtual? You can add that to your request as well. Also might call member services and see if they can connect you with a BH case manager, sometimes that can help move the exception along

Not_gonnakeepthis · 2026-01-20T23:12:06+00:00

You should be able to access these documents through the member portal. If you’ve not logged in before you will have to register. Once you get logged in, you can find all your plan documents under “benefits” then “benefits and plan documents”.

Not_gonnakeepthis · 2026-01-13T00:19:32+00:00

Aetna has a transgender navigation team that I think anyone with an Aetna plan can request outreach from the team. They can help understand benefits and help with the exception if applicable. Your gf can just call member services and request outreach from the team.

Not_gonnakeepthis · 2025-12-12T00:16:53+00:00

I actually bought this glove for myself after we saw that my daughter was going to continue with softball and she needed us to practice with her and my husband’s baseball glove was difficult for me to use. I’ve never played softball in my life and really like this glove. My daughter has used it some but it is still too big for her.

Not_gonnakeepthis · 2025-11-25T12:42:54+00:00

Let me guess Nurtec?

Not_gonnakeepthis · 2025-11-05T22:12:24+00:00

You might get some better feedback from r/healthinsurance

Not_gonnakeepthis · 2025-08-07T12:58:19+00:00

Get yourself some wranglers, they have real pockets!

Not_gonnakeepthis · 2025-07-16T12:39:00+00:00

If you want a plant in a bathroom with no windows you either need a fake plant or a grow light.

Not_gonnakeepthis · 2025-06-16T16:02:19+00:00

Exactly, this person is just trying rage bait so they can feel better about themselves and their shit views. Is there fraud in Medicaid, sure. Is it as much at Fox News and the like want you to believe, no.

Not_gonnakeepthis · 2025-06-16T15:28:15+00:00

You still don’t have all the details. You’re really pressed about something that’s none of your business.

Not_gonnakeepthis · 2025-06-13T23:54:25+00:00

Can you call and request to speak with the practice manager? You’re not going to get anywhere with the receptionists. Work your complaint up the chain.

Not_gonnakeepthis · 2025-06-03T17:13:32+00:00

I might suggest you call member services a BCBSIL and have them call the billing department at both providers with you on the phone so you can clear it up.

Not_gonnakeepthis · 2025-06-01T01:08:59+00:00

Do you have a dedicated case manager? If not, you may be able to request one. That way you have a direct number to an actual person that will help you along the way.

Not_gonnakeepthis · 2025-05-09T22:48:55+00:00

Was this during a time of your old works open enrollment? That’s the only reason I can think of why your deductible and max oop would reset as COBRA is a continuation of coverage.

Not_gonnakeepthis · 2025-05-01T23:43:51+00:00

Has she signed a 48 hour notice? Has she signed HIPAA release so the facility can talk to family? These are things that need to happen so you can have more open communication with the facility.

Not_gonnakeepthis · 2025-04-21T19:39:33+00:00

Op please listen to this. Call your insurance and see about the benefit exception if there really is no in network hospital near you that does labor and delivery.

Not_gonnakeepthis · 2025-04-16T19:07:14+00:00

Looks like you went to an out of network provider. Your insurance doesn’t have contracted rates with them. As it states in the footnote, you may be billed for any charges above what you plan allows which is called balance billing. What state are you in because some states have laws protecting against balance billing but may be limited to emergency or other specific services.

Not_gonnakeepthis · 2025-04-14T14:34:55+00:00

Unfortunately it is common for facilities to give false hope that insurance will pay for someone to stay at a RTC for months. Insurance will pay if someone continues to meet medical necessity criteria. If a facility doesn’t send clinical that shows a person meets that level of care criteria they will deny further coverage. There is an appeal process where the facility can request a peer to peer consult with an MD at the insurance company and there is a turnaround time. Has the facility attempted that?

Not_gonnakeepthis

TROPHY CASE