If your employer is sponsoring a health plan with Planstin’s help, the health plan likely uses reference-based pricing (RBP) to help prevent inflated healthcare costs. What is RBP? Reference based pricing, or RBP, is a healthcare pricing system that uses reference points to determine the value of a service. The reference point Planstin-managed health plans primarily use is the Medicare reimbursement rate. This reference-based pricing strategy can result in savings for both you and your plan sponsor. How to talk to your provider about RBP Though your provider may not be familiar with third-party administrators, like Planstin, they are likely familiar with reference-based pricing. Once you have located a provider, be sure to discuss your service in advance. Inform your provider that your health plan uses reference-based pricing before making an appointment. Doing so will ensure that you and your provider are on the same page before you receive care. Do you have a plan that uses RBP? Your employer may have designed a plan with us that requires the use of the PHCS Network. In this case, you are free to choose a provider within that network using the search tool located here . If you are unsure if your plan uses this network, you can call 888-920-7526 .
If your employer is sponsoring a health plan with Planstin’s help, the health plan likely uses reference-based pricing (RBP) to help prevent inflated healthcare costs. What is RBP? Reference based pricing, or RBP, is a healthcare pricing system that uses reference points to determine the value of a service. The reference point Planstin-managed health plans primarily use is the Medicare reimbursement rate. This reference-based pricing strategy can result in savings for both you and your plan sponsor. How to talk to your provider about RBP Though your provider may not be familiar with third-party administrators, like Planstin, they are likely familiar with reference-based pricing. Once you have located a provider, be sure to discuss your service in advance. Inform your provider that your health plan uses reference-based pricing before making an appointment. Doing so will ensure that you and your provider are on the same page before you receive care. Do you have a plan that uses RBP? Your employer may have designed a plan with us that requires the use of the PHCS Network. In this case, you are free to choose a provider within that network using the search tool located here . If you are unsure if your plan uses this network, you can call 888-920-7526 .
Planstin provides free: Aid to those with disabilities to help them communicate with us, such as sign language interpreters and written information in other formats (large print, audio, electronic formats, other). Language help for those whose first language is not English, such as Interpreters and member materials written in other languages. The plan must provide, upon request, a notice in any non-English language. Assistance with filing claims and appeals in any non-English language. Language Access Services For help, please call Benefit Advocacy at 888-920-7526 (TTY users: 711). Spanish (Español) : Para obtener asistencia en Español, llame al 888-920-7526. Traditional Chinese (中文) : 如果需要中文的幫助, 請撥打這個號碼 888-920-7526. Navajo (Dine) : Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 888-920-7526. Pennsylvania Dutch (Deitsch) : Fer Hilf griege in Deitsch, ruf 888-920-7526 uff. Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 888- 920-7526. Samoan (Gagana Samoa) : Mo se fesoasoani i le Gagana Samoa, vala’au mai i le numera telefoni 888-920-7526. Carolinian (Kapasal Falawasch ) : ngere aukke ghut alillis reel kapasal Falawasch au fafaingi tilifon ye 888-920-7526. Chamorro (Chamoru) : Para un ma ayuda gi finu Chamoru, å’gang 888-920-7526.
Machine-Readable Files (MRFs) In compliance with The Transparency in Coverage Rule (TiC), health plans and health insurance issuers must publish two Machine-Readable Files (MRFs) containing in-network and out-of-network details. About Transparency in Coverage (TiC) The Transparency in Coverage Rule requires most health insurance issuers and group health plans to disclose pricing and cost-sharing information to participants, enrollees, and beneficiaries. Pricing information includes billed charges, negotiated rates, and allowed amounts paid for out-of-network providers using two Machine-Readable Files (MRFs).
Group health plans managed by Planstin offer preventive care coverage as outlined by the ACA. Some plans may require that these preventive services be performed in-network for coverage. Not all plans cover diagnostic exams. Note: Please see your plan’s Statement of Benefits and Coverage (SBC) or call us a t 888-920-7526 for specific details about your plan. What is a preventive health screening? A preventive health screening, such as a colonoscopy or mammogram, is performed as a part of your routine health care. Your doctor may order one once you reach a certain age to ensure there are no unseen health changes. What is a diagnostic health exam? A diagnostic health exam, such as a diagnostic colonoscopy or mammogram, is performed when you or your doctor are concerned about changes in your health. Your doctor will order a diagnostic exam to try and find the cause of your symptoms and to make a medical diagnosis.
After getting a denial or refusal from your health plan, you or an authorized person have 180 days to appeal it. This appeal process is for situations like denied benefits, unpaid services, or canceled coverage —otherwise known as an Adverse Benefit Determination. How to appeal You may request an appeal by sending a written request to the following address: Planstin Administration ATTN: Claims/Appeals 1506 S. Silicon Way, Suite 2B St. George, UT 84770 Please include the following information in your written request: Member Name & Date of Birth Member ID & Group Number Claim Number Date of Service Name of Provider Reason for Appeal During the appeal process, all comments, documents, and information related to your claim will be reconsidered, regardless of whether they were looked at before. The review will be handled by a new decision-maker from the plan, who wasn't involved in the original denial. This ensures an unbiased, fresh review of your appeal.
If you have an employer-sponsored, Planstin-managed health plan, it includes preventive care as outlined by the Affordable Care Act. All of these preventive services are 100% covered by your plan. Your 100% covered preventive services include: Annual Wellness Visit Health Screenings Immunizations Cancer Screenings Child's Vision Acuity Screening You can access the full list of preventive services here . If you receive preventive care covered by your health plan, your plan will take care of the bill. If, for any reason, you receive a bill for preventive care from your provider, contact a Benefit Advocate at 888-920-7526 .