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/Specialist_Dig2613 Jul 27 '25

If I were you I'd take the job because of the insurance. You payroll deductions could easily be half of a network plan with better benefits. The number of doctors that won't be happy with 150% of Medicare pricing is tiny. It's absurd to denigrate companies that choose RBP plans. Companies that have network HMOs with high deductibles are the ones that hate their employees.

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u/QuantumDwarf Jul 27 '25

Uh… working in the industry there’s virtually no provider who will accept 150% of Medicare. Even less who will accept 150% of Medicaid.

It might be a ‘fine’ choice for people who are otherwise generally healthy but absolutely horrific for anyone with a chronic illness.

Every plan I know who went to RBP either carved out their execs onto a ‘normal’ plan with OOPM / low copays / etc or switched back as soon as someone at the exec level had a family member who actually needed care.

So ironic as they are the ones who could actually afford RBP, but hey - execs gotta exec!

-13

u/IndyPacers Jul 27 '25

It's funny how different experiences can be.

I've seen cancer treatments, open heart surgery, etc all be done through reference based pricing programs. I'm confident I've had clients pay out at least $30mil in claims on RBP over my short career.

RBP has some struggles, not going to act like it doesn't. But it also works in many areas great.

15

u/QuantumDwarf Jul 27 '25

Your clients - employers? How many people with chronic illnesses have you talked to about their experiences before and after RBP?

I am sure it IS great for employers - another way to pass the cost of health care that THEY can’t afford to their employee.

Everytime I see a company who says they can’t afford the cost of their employees healthcare I wonder how they think their employees are going to be able to afford paying all of the balance bills above the ‘fair price’ that they pay.

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u/IndyPacers Jul 27 '25

I promise you, I have talked to hundreds of employees. My phone # goes out as part of open enrollment and ongoing communication.

RBP alone doesn't support employees. I agree, no argument from me.

But direct contracts at better prices than default networks with at least 75% of the most commonly utilized providers and facilities for that particular groups claim history, wrapped with well trained advocacy and RBP works very well. Maybe throw in DPC or a mobile clinic to support folks more, depending on what the budget allows.