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/LizzieMac123 Moderator Jul 27 '25

https://resources.planstin.com/help-center/what-is-reference-based-pricing03de4340

Basically, your insurance now has a max price theyll pay for every cpt visit, test, procedure- regardless of which provider you go to. So, you taking an active role in finding the cheapest price is going to save you the most money.

Pros are typically- you can pick any provider you want to go to.

Cons are that the referece price may not cover the full cost, leading to balance billing if there is no network agreements between insurance and the doctor.

In my opinion, this is NOT a good set up and its a sign of either a struggling company trying to save a buck or a company that doesnt care about its employees as now you have to call around to find the lowest prices.

If your plan has generous allowances and/or you have ample doctors near you, it will be easier, but if its something like 150% of medicaid pricing, that is going to be harder because medicaid has such low reimbursements, thats why many doctors arent in network with medicaid.

If i were you, id start looking for a new job.

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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/EmberOnTheSea Jul 27 '25

The number of doctors that won't be happy with 150% of Medicare pricing is tiny.

Such a ridiculous statement could only come from someone on the sales side of things.