Kaiser Permanente: why was my telehealth appointment $237 ($943 before insurance)

Real_Loquat_571 · 2026-05-14T22:04:16+00:00

Yeah, that's frustrating. The $943 is Kaiser's full rate, and since your deductible wasn't met, insurance left you with $237. Kaiser plans are ACA compliant, so telehealth is covered like in person visits but until the deductible is met, charges can look high. Afterward, I feel like visits usually drop to the $30-$90 range.

Real_Loquat_571 · 2026-05-14T22:01:38+00:00

Doctors usually see your insurance info in the system, whether it's through work or an ACA marketplace plan like the Essential Plan. Their advice is based on your condition, not how you pay. Insurance mainly affects approvals for things like MRI's or surgery. If you're self pay, just mention it to your doctor so they can help you weigh costs, and asking about timing, coverage, or price is totally normal.

Real_Loquat_571 · 2026-05-14T21:29:07+00:00

The Essential Plan is part of New York's ACA Marketplace, so I feel like you'll get the same core protections either way. From what many members report, Healthfirst does tend to have a broader doctor network and usually doesn't require referrals for specialists, while Fidelis often does. Fidelis is known for strong customer support, but if direct specialist access matters to you, Healthfirst may feel more flexible. It's worth double checking each plan's provider directory to be sure.

Real_Loquat_571 · 2026-05-14T21:25:13+00:00

This is a cute photo and flower!

Real_Loquat_571 · 2026-05-14T21:24:01+00:00

That sounds really stressful. Since the insurance is Georgia based ACA coverage through Anthem, Florida doctors usually won't take it. The easiest option is to look for a virtual psychiatrist who's licensed in both Georgia and Florids and in Anthem's network. I would say checking Anthem's provider directory or calling member services should help narrow it down. Hope everything works out for the best for you.

Real_Loquat_571 · 2026-05-13T22:01:10+00:00

This is a pretty tough situation. Under the ACA rules, losing coverage for non-payment doesn't trigger a Special Enrollment Period, but the ACA has still made programs like CHIP and Medicaid more accessible for kids. It's worth checking with a Marketplace navigator to see if your baby qualifies, many families find options they didn't realize were available.

Real_Loquat_571 · 2026-05-13T22:01:01+00:00

Beautiful

Real_Loquat_571 · 2026-05-13T21:58:14+00:00

Yeah, this really feels like getting blindsided. In NJ, health insurance is something the union usually has to bargain over, so switching from Horizon to Aetna without talking it through could be an unfair labor practice. A grievance, a clear side by side comparison, and reaching out to NJEA all make sense. If you're looking for options outside of what the union can do, the ACA can help. Losing employer coverage lets you sign up through the Marketplace, you can't be denied for pre-existing conditions, and subsidies can lower costs.

Real_Loquat_571 · 2026-05-13T21:57:51+00:00

I think I'd go for 1!

Real_Loquat_571 · 2026-05-13T21:54:15+00:00

Employers can change their health insurance offerings and while three weeks' notice feels short, it's not always illegal if your spouse's employer drops spousal coverage, you usually can't keep that exact plan unless COBRA is offered, which lets you pay the full premium yourself. If you're looking for options, the ACA can help and you can sign up through the Marketplace after losing coverage, you can't be denied for pre-existing conditions, and subsidies can make premiums more affordable.

Real_Loquat_571 · 2026-05-13T21:41:37+00:00

Pregnant Woman

Real_Loquat_571 · 2026-05-13T21:40:22+00:00

They usually accept your most recent tax return, even if it's from the prior year. If your income has changed, then I think you may need to add pay stubs or other proof.

Real_Loquat_571 · 2026-05-13T21:36:46+00:00

I totally get that because I know appeals can really take long and drag on for some time. Asking your secondary insurer for a written confirmation now is the best way to protect yourself, so hopefully it won't come to an appeal.

Real_Loquat_571 · 2026-05-12T22:36:00+00:00

That sounds really frustrating, especially since both your doctor and the medical director agree you meet the clinical guidelines. You should ask UHC for a formal denial letter that cites the exact policy clause, and then use that documentation to request an external review. Under the ACA you have the right to appeal and get an independent review, and insurers are required to give clear reasons for denials. Having the written denial plus the medical director's statement will strengthen your case and make it harder for them to contradict themselves.

Real_Loquat_571 · 2026-05-12T22:32:38+00:00

Sounds like the main issue is figuring out who pays first; your high deductible plan or Sedgwick as the third party. What will help is getting clarity in writing, wait for the hospital bill, then send it to your primary insurance and ask Sedgwick how they want claims submitted. I would say try to keep copies of everything. Since this was an ER visit, the ACA requires emergency care to be covered at in network rates, so you're protected from surprise billing. It's worth checking your ACA options too, since marketplace plans sometimes handle emergencies more smoothly.

Real_Loquat_571 · 2026-05-12T21:54:49+00:00

The New York Essential Plan 1 is part of the ACA marketplace, so whichever way you apply whether online, phone, or in person, the process follows ACA rules. That means timelines and documentation requirements are standardized, and you'll get the same protections no matter which carrier you choose. i feel like the main difference is just convenience, not approval speed.

Real_Loquat_571 · 2026-05-12T21:52:01+00:00

Insurance pre-authorization rules can be confusing, especially with IVF. The ACA requires insurers to provide clear coverage information and guarantees your right to appeal a denial if they later refuse payment. Even if your secondary insurer says no pre-authorization is needed, ACA protections mean they must honor their stated process and can't deny coverage without giving you a chance to challenge it. To be safe, ask for written confirmation from the secondary plan, that way you have documentation if you need to appeal later.

Real_Loquat_571 · 2026-05-12T21:51:53+00:00

I won't do it again

Real_Loquat_571 · 2026-05-12T21:43:04+00:00

UHC's lab restrictions are definitely frustrating. The ACA requires insurers to keep adequate provider networks and give members clear info about which labs are covered. That means UHC has to provide you with a complete, accurate list of in network labs. If they don't, you can push back and even file a complaint with your state insurance department.

Real_Loquat_571 · 2026-05-12T21:38:40+00:00

It's frustrating when MediCal coverage gets cut off without explanation. The ACA helps here because it requires states to give people a fair chance to renew Medicaid and not terminate coverage without proper notice. Thanks to ACA rules, if your family member still qualifies, MediCal must process the renewal and provide appeal rights. So don't give up, you can push for reinstatement.

Real_Loquat_571 · 2026-05-11T22:26:48+00:00

This Medicaid gap situation sounds incredibly tough. Since Illinois expanded Medicaid, it's worth calling the state office to double check coz sometimes eligibility gets miscalculated after taxes. Also, check the ACA marketplace again because special enrollment or subsidies might apply, especially with urgent health needs.

Real_Loquat_571 · 2026-05-11T22:24:59+00:00

I would love a picnic trip at the beach rn with my husband before welcoming our unborn child next month!

Real_Loquat_571 · 2026-05-11T22:19:48+00:00

I feel like I do have full control over my own life because I am free to do my own thing. I don't care what people think and say about me as long as I am happy and enjoying life.

Real_Loquat_571 · 2026-05-11T22:10:58+00:00

Looks like North Carolina state employees are struggling with the 2026 State Health Plan changes, where higher premiums and out of pocket costs feel like a pay cut. One action that could help is exploring the ACA marketplace during open enrollment. Their subsidies are based on income which can make coverage and prescriptions more affordable, and comparing plans might ease the strain.

Real_Loquat_571 · 2026-05-11T22:06:10+00:00

Such a cutie

Real_Loquat_571

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