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g/emergency-room

ER claim denied as 'not medically necessary' - chest pains at 2am, what was I supposed to do?

I went to the ER in January because I woke up with severe chest pains radiating down my left arm. I'm 34, no history of heart problems, but I was terrified. Turns out it was a severe panic attack,...

Posted by claimFighterKaren82•7h ago
4 comments
g/collision-claims

Adjuster offered me $4,200 for my car - KBB says it's worth $9,800. What do I do?

My car got rear-ended two weeks ago by someone who ran a red light. Their fault, 100% on camera. Their insurance accepted liability no problem. Then came the offer. $4,200. For a 2019 Honda Accord...

Posted by frustrated_policyholder•10h ago
5 comments
g/total-loss

Insurance totaled my car and valued it at $4,200 - the exact same car is selling for $9,500 near me

My 2017 Hyundai Elantra with 61,000 miles got totaled last week. No major mechanical issues, clean interior, new brakes in September. The adjuster just sent the total loss valuation and it came in at...

Posted by confused_homeowner_579•1d ago
5 comments
g/workers-comp

Workers comp approved my back surgery, then denied the claim saying injury wasn't work-related - what?

I don't fully understand how this is legal. I hurt my back at work in November moving equipment. Filed a workers comp claim. My employer's insurer - Sedgwick - had the claim approved, sent me to their...

Posted by curious_buyer_981•1d ago
6 comments
g/workers-comp

Workers comp denied my surgery saying injury predates employment - employer is backing up the insurer's story

I work warehouse jobs and hurt my lower back at work about four months ago lifting a pallet that shifted unexpectedly. I reported it the same day, filled out the incident report, went to the company's...

Posted by anxiousresident236•2d ago
5 comments
g/roof-claims

Roof claim denied - adjuster says damage is from 'wear and tear' but I have neighbors who got paid for the same storm

We had a pretty bad hailstorm come through our neighborhood about six weeks ago. I saw a bunch of my neighbors getting their roofs inspected and a few have already started repairs covered by...

Posted by hopefulResident980•2d ago
5 comments
g/rental-reimbursement

Rental reimbursement cap is $30/day - it's been 6 weeks and my car still isn't fixed. What are my options?

Got rear-ended six weeks ago. Total liability claim against the other driver's insurance (Geico). The other driver was 100% at fault - no dispute on that. My car has been at the body shop for almost...

Posted by hopefulResident980•2d ago
9 comments
g/mental-health-claims

Insurance says my therapist is out-of-network but she's listed in-network on their own website - claim denied anyway

I've been seeing the same therapist for about 14 months. When I started, I verified through my insurer's online directory that she was in-network for my plan with BlueCross. I confirmed it with her...

Posted by confusedseller627•2d ago
5 comments
g/water-damage

Water heater leak destroyed my hardwood floors - adjuster just gave me $4,100, contractor says it'll be $11,500. What now?

Last week our water heater started leaking slowly and we didn't catch it for a few days. By the time we did, about 600 square feet of original hardwood floors had buckled pretty badly. We filed a...

Posted by anxiousresident236•2d ago
7 comments
g/medical-claims

Anthem denied my colonoscopy as 'not medically necessary' - ordered by GI after blood in stool for 3 months

I'm still kind of in shock. My gastroenterologist referred me for a colonoscopy after I told him I'd had blood in my stool on and off for about three months. He said given my age (46), family history...

Posted by hopefulResident980•3d ago
6 comments
g/long-term-disability

My long-term disability insurer wants me to do an "independent" medical exam. Should I be worried?

I've been on long-term disability through my employer's policy (administered by a major insurer, won't name them but you can probably guess) for about 14 months. I have a legitimate diagnosis...

Posted by patient_renter_128•4d ago
5 comments
g/roof-claims

Finally got my ACV roof settlement - but now they're saying I have to pay depreciation holdback even after I replace it?

Had a hailstorm hit our neighborhood in February. Adjuster came out, confirmed damage to the roof, and after two weeks we got a settlement letter for actual cash value: $9,200. Our roof replacement...

Posted by stressedpolicyholder341•4d ago
6 comments
g/medical-claims

Surprise $4,200 bill after "in-network" surgery - anyone dealt with this?

Had knee surgery in October at an in-network hospital with an in-network surgeon. Just got a bill for $4,200 from the anesthesiologist who was apparently out-of-network. Nobody told me this was even a...

Posted by confused_seller_554•4d ago
10 comments
g/claim-denials

Denied for the third time on the same claim - what are my options?

i honestly dont know what to do anymore. i filed a water damage claim back in january after a pipe burst and soaked my basement. first they said "gradual damage not covered." i appealed with...

Posted by confused_homeowner_579•4d ago
6 comments
g/pre-authorization

Three prior auth denials for a CPAP and I'm exhausted - anyone actually win this fight?

I was diagnosed with moderate sleep apnea after a sleep study my doctor ordered. My sleep specialist prescribed a CPAP. Seems straightforward, right? I've now had three prior authorization requests...

Posted by curiouspolicyholder528•5d ago
5 comments
g/collision-claims

Rear-ended at a red light but other driver's insurer says I'm 40% at fault. Is this even legal?

I was completely stopped at a red light on a Thursday afternoon. The guy behind me was looking at his phone and hit me going probably 30 mph. My car has $8,400 in damage, I have a neck strain my...

Posted by stressedClaimant789•5d ago
5 comments
g/collision-claims

Got my collision claim settlement after 4 months - some lessons I learned the hard way

Finally wrapped up my collision claim after a rear-end accident in January. The other driver was clearly at fault but it still took 4 months to get paid out. Sharing what I learned in case it helps...

Posted by curious_buyer_981•5d ago
5 comments
g/claim-denials

State Farm denied my water damage claim saying it was 'gradual damage' - is there any way to fight this?

My basement flooded after a pipe in the wall slowly leaked over time. Didn't notice until the drywall was already destroyed. Filed with State Farm and they came back with a denial citing "gradual...

Posted by confusedHomeowner197•5d ago
7 comments
g/water-damage

My burst pipe claim took 3 months but I finally got paid - here's what made the difference

Sharing this because when it was happening to me I scoured the internet for success stories and couldnt find enough of them. Burst pipe in my crawlspace last January. The water ran for probably 18...

Posted by confusedHomeowner197•6d ago
6 comments
g/medical-claims

Colonoscopy billed as 'diagnostic' because they found a polyp - now I owe $2,800 I thought was covered

I went in for a routine screening colonoscopy. My doctor ordered it, i'm 52, totally standard preventive care. My insurance covers preventive colonoscopies at 100% - no cost sharing. I got the...

Posted by curiouspolicyholder528•6d ago
7 comments

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