r/HealthInsurance • u/Starlight-Seeker • Jul 27 '25

Plan Choice Suggestions How Screwed Am I?

My employer is changing from Cigna to Planstin Administration which is apparently something called a reference based pricing plan. What is this? Please explain this to me in the simplest terms possible.

My benefits manager said that before every single doctor's appointment and every single test (labs, x-ray, etc), I'll need to contact Planstin's Care Coordination Team. I have multiple chronic medical conditions. I see a lot of specialists, get a lot tests done, and take multiple prescriptions.

How screwed am I with this type of health insurance?

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u/CuriousKatMiny Jul 27 '25

This sounds like my husbands new insurance, Sidecar Insurance. Huge rip off and we would probably have better luck being uninsured because they cap prices for every little thing. No 80/20, just “this is what we pay, you go find a cheap provider, and then if you find someone below the amount we pay, we return a whole 50% of the savings! Not all the savings, just half. Welcome to sidecar“.

All I can say is that it’s a freaking nightmare.

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u/Electrical-Ebb-8049 Jul 28 '25

I'm curious how long you've been on it u/CuriousKatMiny. I'm coming up on a year and our family's made around $800. Plus we have lower premiums (saving about $600/mo) and we can see literally any provider we want. Sometimes we do choose to pay more for a certain doctor but in almost every case that amount has been less than our old plan's copay.

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u/CuriousKatMiny Jul 28 '25

Only a few months. Our monthly premium is actually $75 higher than we were paying, and we were previously given a $3000 FSA card that was taken away. This has not saved us a dime. A normal Dr visit would have a copay and cost $50. I’ve only gone to the Dr once since we had it switched on us and it and it cost me $230 out of pocket. Because I was sick and needed an antibiotic. Now, I’m scared to return if I get sick again. In fact, I can’t even use the “credit card” issued by the insurance company until that balance is paid off (which it has about $50 balance left).

We have to get our two kids a wellness check and vaccinations before school begins in august. This previously cost us NOTHING. I’m literally so anxious about what these visits are going to cost us now. They won’t be free!

Not to mention having to submit all the information to the insurance myself. Like, the convenience of the dr office doing all that and me paying copay was well worth it so that I didn’t have to do all the legwork. And they want the sick and ill to “shop around for the best price”?! Give me a break, since when I’m sick id much prefer to go by whoes the best provider, not who offers a discount.

It’s SO embarrassing trying to explain the insurance to a doctor office. The corny script the insurance company sends to assist with this can suck it.

It’s cool you’ve had a good experience, but we have not, and only see this getting worse.

SidecarInsurance