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/SuspiciouslyGreat23 Jul 27 '25

If you call, you may find them helpful for coordinating your care and you should be paying significantly less for premiums and out of pocket costs.

If you know you don't want to deal with all that, then sure look for a new employer. However, I will say you may be hard pressed to find an employer who can afford to offer insurance that is (1) low premiums (2) low out of pocket costs and (3) has no restrictions. If you can find some, let us know.

HMOs, HDHPs, etc. all generally satisfy 2/3. Any carrier limits you by the network.

Employers are scrambling to find better ways to deliver all 3 but it only happens with some engagement from employees.

RBP CAN be one of those ways, but without more details cannot say for certain. In my experience with clients, when we roll out RBP solutions, employees are asked to call but not required to. The plans cost 50% less or more and typically better benefits (lower copays, lower deductibles etc.). There is a risk of balance billing, but it should be small and the employer may already have a way to address that.

I would first ask about what happens if you don't call and what happens if you get balance billed. If they don't commit to helping remove that risk, then definitely leave!

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u/Accomplished_Boat499 Jul 27 '25 edited Jul 27 '25

Agree. There are several RBP plans that work well, but it depends on a lot of factors on how the plan was setup. Is there balance bill protection built in? I would assume by using the concierge there is.

A few things to consider… on some plans you can have RBP for hospital services but a PPO you can use for providers, urgent care, etc.

For prescriptions, RBP shouldn’t be a factor but you’ll want to ask for the formulary list and check where/how your scripts are covered.

Lastly, it’s very location dependent. For example, if you only have one major hospital system around you, they are more likely to push back on how your plan pays and balance bill.