For context, I was previously insured through Innovative Partners: MultiPlan PPO, which I enrolled in after speaking with someone from the Massachusetts Health Connector. I had this insurance from January 2024 through December 2025, although my last appointment under their coverage was in January 2026, since my coverage remained active until the end of that month.

A few months ago, the Federal Trade Commission (FTC) shut them down and filed a lawsuit against them. I actually received an email about the situation back in July, but unfortunately, it ended up buried in my junk folder, and I didn't see it until much later.

Fast-forward to September 2026, and I'm suddenly being billed for every single appointment I had between January 2024 and January 2026.

I understand that Innovative Partners was shut down. What I don't understand is how my hospital, Tufts Medical Center in Boston, could have been accepting my insurance information for TWO YEARS, apparently receiving no payments whatsoever, and never once informing me that there was an issue.

For two years, I continued attending appointments under the impression that everything was fine. My patient portal consistently showed a $0 balance, so I had absolutely no reason to believe anything was wrong. Had someone at Tufts informed me that my insurance claims weren't being paid or that they weren't receiving responses from my insurer, I would have taken action immediately. I could have investigated the situation, switched insurance providers, or at least avoided accumulating two years' worth of unpaid medical bills.

Instead, I'm now stuck facing over $2,000 in medical bills that I had no idea were accumulating.

Looking back, I genuinely wish I had been smart enough to recognize the red flags surrounding Innovative Partners. I wish I had questioned things sooner. But more than anything, I wish Tufts Medical Center had communicated with me about what was happening behind the scenes.

How was I supposed to know there was a problem when the hospital continued accepting my insurance, scheduling my appointments, and showing a $0 balance on my patient portal?

I feel completely blindsided. I'm frustrated with Innovative Partners for putting people in this situation, frustrated with Tufts for the apparent lack of communication, and frustrated with myself for not catching on sooner.

I'm just so incredibly pissed off right now. Two years of appointments, zero warnings, and now a $2,000+ bill that seemingly came out of nowhere. I'm wondering if writing to them will make a difference, idk...

Hi everyone,

I am from abroad and still trying to figure out some aspects of the Health system in the US.

To puy it simply, I received a quote from a dental healthcare provider for these amounts (see table).
My maximum coverage had only 1350 USD remaining, so I would have to pay around 4200 Dollars if I would do all the treatment with their fees.

I checked on UHC contracted rates for in network, and they are nothing like what I was shown and asked (almost pushed) to pay (through a 0% APR Cherry financing or so I understood).

The last two columns show the total contracted rates for those codes, and what I would be paying.
The office manager at this place started being very unresponsive and gave me a hard time to share unmarked, complete medical records when I asked them to then get a second opinion and quote.

I also asked the office manager to please do a pre-approval check with UHC so I can then call the insurance and know for a fact what I am going to really pay... she has not comeback on that request and does not seem in a hurry to do it. - How would you proceed a situation like this?

Thanks.

Hi! I recently got promoted to FT in my current role and am now eligible to benefits.

Work covers 100% of employee health insurance and am having trouble deciding which plan is best for me: HDHP (left column) or PPO (right column).

Context: 24 yrs old living in LA county, previously under MediCal, haven’t been to a doctor since just before COVID coupled with aging out of pediatrician during the pandemic + local providers are mainly out of network with MC. I get paid weekly.

Have kept up with dental & vision (latter kind of). So these two are expected medical costs but I want to start up again with routine Dr visits with this new enrollment. I don’t really understand the deductibles/co-insurance of it all and what the rate per pay period means if I go with the PPO option if work is meant to cover 100%.

I like the idea of an HSA but have heard if employer offers full coverage, it’s best to go with a PPO. Any advice + breakdown of either options?

Has anyone used Health Access Solutions Cooperative for their insurance-alternative? I'm considering it, but I'd like to know if anyone's had anything "major" (expected, or unexpected surgery, accident, significant diagnosis, etc) using this, and how that went for them with reimbursement.

I enrolled in an ACA Marketplace plan in Texas in November 2025 for 2026 coverage. At the time, I genuinely expected to find employment and earn approximately $20,000 during 2026.
Unfortunately, due to a chronic health condition and the difficult job market, I haven’t been able to find work, and my actual income for 2026 is likely to be $0.
My monthly insurance premium is approximately $950, and I receive $550/month in advance premium tax credits.

I understand that starting with tax year 2026, the repayment caps for excess APTC have been eliminated. I’m also aware that Texas hasn’t expanded Medicaid, so someone with $0 income generally falls into the coverage gap.

So do I have to pay back over $5000 when I file taxes next year ?

I am getting conflicting information on this:

According to agentbrokerfaq.cms.gov, if the estimate was good faith then you don’t have to pay back. Here in the text:

“If a consumer was enrolled in Marketplace coverage with APTC for one month or more based on estimating their household income to be at least 100% of the federal poverty level (FPL), and the consumer did not intentionally or recklessly misrepresent their household income when enrolling in the coverage, IRS rules state that this consumer may still qualify for and claim the premium tax credit on their tax return even when the household income as reported on their tax return is below 100% of the FPL.
 
This rule is not affected by Section 71305 of Public Law 119-21 that, for Plan Year 2026 onward, eliminates the excess APTC repayment limitations and requires consumers to repay all of their excess APTC, which is the amount of the APTC for the year of coverage that exceeds the premium tax credit allowed for the year.  For years before 2026, excess APTC repayment amounts were capped for consumers with household income below 400% of the FPL. 
 
The IRS has authority to deny the premium tax credit to an individual whose household income as reported on their tax return is below 100% of the FPL and who, with intentional or reckless disregard for the facts, provided incorrect information to the Marketplace in order to get APTC (e.g. intentionally or recklessly provided inflated household income to the Marketplace that was greater than or equal to 100% of the FPL to get APTC).”

[ Removed by Reddit on account of violating the content policy. ]

I’m in Arizona and looking for advice from anyone who has dealt with something similar.

My GI doctor and his main office were in-network. Before my endoscopy, the office said they checked my insurance. However, the procedure was performed by the same doctor in a separate endoscopy suite next door, which was processed as out of network. Now I’m facing a $7,000 bill.

When I spoke to the GI billing department they told me “at the time of the procedure you were shown as in network so you’ll need to appeal.”

It’s been several weeks since I started the insurance appeal and no update on either ends. But I saw I am expecting certified mail from the GI office which I assume is the $7000 bill.

Their website operates as both the GI office and endoscopy office. It also states we are in network.

I’d appreciate any advice or experiences with successfully appealing a bill like this!

Sooo, I was troubled to receive a letter in the mail from Marketplace informing me my premium would likely go from $174 to $360 ish a month. But I saw in the news that Virginia has new premium subsidies through the state. I ran my family numbers through a calculator and the expected state subsidies on top of federal discounts are opening up new choices I didn't have available last year.

Bronze HSA HMOs with $0 monthly premium but high deductibles. Some with $50 copays and some with 35% coinsurance after deductible is met.

Silver CSR compatible HMOs starting at $184/month premium, about $6000 deductible and $15 copays

Gold HMOs starting at $156/month $3150 deductible, $5 copay ($20k out of pocket max)

Now I'm even more confused as to what I should choose. I've never used the CSR Silver plans before, as the premiums have been too high for me to afford. I don't really understand how they work.

I'm shocked there are gold plans cheaper than what I'm paying for a Bronze Anthem BCBS 7500 right now. I did that plan and opened a HSA last year. I never did put anything in it. We never had any extra income between kids with cavities, car repairs, out of town funerals, and a tank of gas costing $75 a pop. My employer is too small to offer health insurance, so can't contribute. Anything I put in will be after taxes.

We're a family of 4 with an expected income around $75,000 or a little over. The hubs has his insurance paid 100% by his employer. So it's me and the kids. We have a few health conditions but nothing super expensive. My son's ADHD checkups and meds are the most important thing.

My brain says I should go with a 0 premium plan and commit to putting $$ into the HSA I opened. I worry I won't actually do it. But it's possible. I have been capable of saving money in the past. (my pre-kid era)

I wonder if I'm really missing out on not using one of the CSRs if they lower costs pretty well on the back end?

The "safe" option would be to snap up that Gold plan, and have peace of mind. But then I'd be missing out on the opportunity to stash money in the HSA we could put to better use.

My husband prefers I make this type of decision as he doesn't feel comfortable.

What would you do if it were you?

Hi,

I completed a sleep study recently and received a bill with $3100 on it. My insurance discount brought it to $1670. But I believe that is still high for a sleep study done with equipment that cost $100.

On top of that, I get charged $270 ( $110 with insurance discount ) for a doctor to read the results.

I'm already tired of discussing it, and they want to send my bills to collections.

On top of that, a staff member told me I would not have to pay for the things for the at-home sleep study. Now I'm at my wit's end. don't know what to do. I'm getting charged ~$1800 to sleep in my bed with $100 equipment that I don't own.

Edit 1:

• EEG (Electroencephalogram) - General Classification: $3,056.00
  • HC Sleep Study Unattended - 95806 (CPT): $3,056.00 ( ~$1600 after insurance discount )

I was told I was infertile years ago and have unexpectedly found myself pregnant after being given a 0% chance of conceiving without fertility treatments. My current insurance through UShealth doesn’t cover any maternity care at all, which we knew when we got it.

My husband and I both in our 20s, both work and I’m pretty certain we’re over the income cap for Medicaid. I’m self employed and I guess I could stop working to try to qualify for Medicaid, but losing half our income doesn’t seem like a bright idea either.

I have no idea what to do here. I don’t know if I should try to get a second insurance plan as open enrollment starts or switch insurance plans but we really can’t afford a huge premium right now. As it is I pay $320 a month already (my husband is still on his parent’s insurance).

I have preexisting health conditions and it’s pretty much certain I would have complications. Our hospital bill could be close to $100k if not significantly more.

Are we completely screwed financially? I’ve called the hospital’s billing department and no one seems to have any idea of how much we might be paying for even a single routine prenatal checkup.

My husband was born with a heart defect and essentially bankrupted his parents. They had “good” insurance and made a ton of money (so didn’t qualify for any assistance) and they’re still paying off the bill from his hospital stay 20+ years later (I believe it was over $2.3 million)

Hi I’m 22 and I work a part time job (working on getting a second part time or a better full time job currently). I don’t have enough hours to get my jobs health insurance, and my state hasn’t expanded Medicaid through the ACA. It’s Southern Alabama, if it matters. I just went this whole year not having health insurance or anything and it’s been so expensive! My glasses broke and I went to the doctors office ONCE. I’m still paying this stuff off. I can’t afford any of the insurance I see on Healthcare.gov so I’m not sure what my options are. Idk I’m happy to answer any questions. I just don’t know what to do.

hello , so i just got a bill for $500 because my primary care doctor billed a cost as “ employment cheek up”

so I’m a grad student going into health care. as part of my degree I need to go in felid work/ clinic rotation. for my last rotations I needed a drug test.

the drug test place would only do it if I got a script. my doctor said they can’t just give me a script since I have been in the office for some time. so I went in, literally talked to the guy for 5min or less and he wrote the Dman thing.

now, a few months later I have a $500 bill???

any advice on how I can deal with this? because app my heath insurance dose not cover “ employment“ visits

note: I’m currently unemployed As I wrap up school if that means anything?

My work offers 2 blue shield plans. One is a PPO, the other is an HMO where you have the choice of several medical groups.

I currently have the PPO but it over $500 per month for me and child vs ~$180. The payments for services are also higher for the PPO, much higher deductible (2000 vs 0) and out of pocket max (7500 vs 2000).

Most of our current doctors are in network on the HMO through Hills Physicians (California) and we would have access to one of the best hospitals around. Currently pretty healthy but I know that can change in an instant.

I’m afraid of more red tape with the HMO leading to delayed or denied care should we need it. I can technically afford the ppo and would if it protects our health but also don’t sav want to throw money away. I’m trying to figure out if the HMO is a safe choice. Like am I gambling with our health?

Thanks!

I'm in Ohio how can I get insurance in Ohio ?

My husband and I have been married for years, and I’ve always been covered under his employer health insurance. His plan is really good — low copays, basically no deductible, and I’ve never really had to think about things like coinsurance or paying hundreds/thousands before insurance starts covering things.

His union contract apparently has language saying that if a spouse is eligible for health insurance through their own employer, they can’t stay on his plan. We honestly had no idea this was going to affect me until there was a dependent eligibility audit. I actually went digging through the contract myself because something about the audit felt off, and that’s how I found the rule.
We eventually got a letter saying I have to be removed from his medical insurance effective November 1 because I’m eligible for insurance through my job at JCPenney.

So now I’m being forced onto my employer’s insurance, and I’m trying to figure out which plan to choose. I’m leaning toward the Basic PPO because the other options have even higher deductibles. The PPO has a $1,200 deductible, $4,000 out-of-pocket max, $30 PCP visits, $50 specialist visits, and then things like imaging, diagnostic testing, hospital care, etc. can involve coinsurance.

I’ve never had a deductible-based insurance plan before, so this is honestly overwhelming to me. I’m used to paying a copay and being done.

Unfortunately, my husband is the breadwinner in our household, so it’s not like I have a ton of extra income sitting around to suddenly absorb deductibles, coinsurance, hospital copays, prescription costs, etc. I also have ongoing medical issues and actually use my insurance — this isn’t a plan I’m just going to have sitting there untouched all year.

To make it even more frustrating, I’m finding out some of the doctors I’ve spent years finding and actually trust may not even be in-network under the new insurance.
Has anyone else been forced off a spouse’s insurance because their own employer offered coverage? How did you handle switching to a deductible plan for the first time?

Any tips for keeping costs down, figuring out what’s actually covered, avoiding surprise bills, checking prescriptions before enrolling, or just navigating this mess would be really appreciated.

I’m not looking to cheat the system or get around
eligibility rules. I’m just genuinely overwhelmed and pissed that having access to some employer insurance apparently means I have to give up much better coverage and take on a bunch of new healthcare costs.

I currently have Federal Blue Cross Blue Shield standard and my Rituxan infusions for membranous nephropathy are 1,300 each infusion.

I don't qualify for the copay cards, at least that I saw, I tried two, not sure if there is more.

So, I guess I am trying to figure out if I should change my plan, maybe go with basic?

I'm so stressed out and don't feel well. I have already delayed treatment, I was supposed to get my other round in July.

I just need it to be less out of pocket.

37, AZ, gross income 80k

I am not the most versed in insurance and coverages. To be frank I haven’t had it in a few years but am looking at the plans my employer offers. The difference between each is only $14.. which would be the best for someone who doesn’t have any chronic health issues nor takes prescription medications but wants to start getting established care with a primary doctor and also wants to get bloodwork and exams done to make sure everything is working as it should?

Thank you!

Possibly re-entering the workforce after awhile out due to family and health. What are you guys paying for monthly premiums on employer sponsored health plans? Single, single plus kid, and also whole family plan.

I have PT sessions in September for a personal injury and I just had bills and noticed that the clinic billed my workers comp instead of my personal insurance (Medicaid).

Even though whenever I go to my appointment they ask me if Sedgwick is my insurance and I always say NO it's Medicaid and this ISN'T a work injury. Yet they billed the workers comp insurance for the over 5 sessions.

What can I do about these visits now? I lost Medicaid at the beginning of October due to some of the requirements changes.

For context: I am with Tricare, Prime specifically east region. I have been battling for approval from Humana/Tricare so I can get my surgeries done.
Here’s the chronological timeline…
1- appointment with PCP who sent a referral for plastic surgery as he determined that after years of conservative treatment my last resort would be surgery.
2-appointment with Lipedema specialist (which is the only one within a 90 mile radius from me) at the appointment surgeon said he doesn’t bill insurance for this procedure, but they can provide letters and other documents for potential reimbursement.
3-reached out to my benefits counselor and asked how was this possible if this surgeon is listed as in-network.
They looked into it and confirmed he is indeed under a contract with Tricare so they must bill Tricare regardless.
4- received authorization letter from Tricare/Humana to go ahead and move on with the surgery and that letter said that this authorization doesn’t guarantee payment and payment is based on Tricare policy. surgeon submitted the right codes as well as a letter of medical necessity which ended up in my insurance approval.
5- I received this email from them stating that I was indeed approved and had authorization to proceed with the surgery. BUT they wont bill my insurance just for that specific procedure.
I just don’t understand even the benefits counselor was so confused and all this sounds weird to me?