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/Comntnmama Jul 27 '25

In my experience on the Dr office side, a lot of those pts had to pay upfront and be reimbursed like a cost share plan.

I'd look for a new job ASAP.

-33

u/Specialist_Dig2613 Jul 27 '25

And how is an ERISA plan where the plan is obligated to reimburse anything paid by an employee at the amount paid minus a copay like a cost share plan, where it may or may not happen? It isn't. At all.

Take the job. Ignore the comment.

5

u/Comntnmama Jul 27 '25

He already has the job. It's usually a sign your employer is having issues.

On the health care side, people don't end up getting the care they need when they are required to front the insurance companies portion and wait for reimbursement.