Healthcare Plan (US) Questions

[Alcremie]

I'm wondering if anyone here can help me with this....I don't understand this mumbojumbo.

I can choose 4 different health plans. 2 are high deductible plans which I am not choosing. The other is an "Allied with Aetna Network" and the other is Allied "Reference Based Pricing." So does the first one mean I get coverage through Aetna?
The RBP means I can go with whatever provider I want to whether in network or out network and they just negotiate the prices.

The reason I am asking is that my adhd/dyslexia specialist takes Aetna, I see nothing about Allied which I guess is just 3rd party stuff? Idk.
I have no clue if I can go to them with these insurances but I kind of need to. Their office is closed today and getting answers from my benefits team takes a couple of days.
I don't know if I can be seen with either of them but the RBP is $13 less than Allied w/Aetna so I'd prefer that, but if I can't use any of these with the specialist I'm kinda screwed.

I already checked the marketplace and those are laughably expensive even with the full tax credit included. If anyone can help provide more info on the 2 plans I'm looking at that'd be super helpful, will +rep of course.

[Buizel]

I actually work in health insurance so hopefully I can help. "Allied with Aetna" usually does mean you'd be enrolling into an Aetna policy. In some states, you can get health insurance without a specific plan sponsor, aka, from your job. Thus, you'd get the options you're currently choosing and those options could be aligned to a specific health insurance carrier, which is better since the policy is more controlled, over getting insurance without a health insurance like Aetna backing it.

RBP can also get iffy since each provider could have a different negotiation rate, but with an allied health insurance plan like the Aetna one, you'll see a consistent pricing based on contractual rates with the health insurance. With RBP, you could be paying different prices each time, higher or lower, and that $13 less that it is now, could be increased or decreased based on the provider you see. So, that's something to keep in mind with places that negotiate pricing.

Personally, I say go with the allied plan with a health insurance, but always double check with your provider since they can call and also be told if that's included in their contract (I know you said they're closed, just saying for the future).

Hope this helps!

[Alcremie]

I actually work in health insurance so hopefully I can help. "Allied with Aetna" usually does mean you'd be enrolling into an Aetna policy. In some states, you can get health insurance without a specific plan sponsor, aka, from your job. Thus, you'd get the options you're currently choosing and those options could be aligned to a specific health insurance carrier, which is better since the policy is more controlled, over getting insurance without a health insurance like Aetna backing it.

RBP can also get iffy since each provider could have a different negotiation rate, but with an allied health insurance plan like the Aetna one, you'll see a consistent pricing based on contractual rates with the health insurance. With RBP, you could be paying different prices each time, higher or lower, and that $13 less that it is now, could be increased or decreased based on the provider you see. So, that's something to keep in mind with places that negotiate pricing.

Personally, I say go with the allied plan with a health insurance, but always double check with your provider since they can call and also be told if that's included in their contract (I know you said they're closed, just saying for the future).

Hope this helps!

THANK YOU for explaining like I'm 5 years old. I'll just go with the Aetna one, and hope it works. I had Aetna before (though the deductible &OPM was a lot lower...but that's what happens when you go from big corp to non-profit). I just got spooked cuz I didn't see Allied on any of my docs insurance lists but they do have Aetna.
I don't really have a choice but this one.., and you're right, I do not feel like dealing with the fluctuating negotiation prices each time. I am glad that the specialists are just a small copay. The ones on the marketplace didn't cover anything with like $9,000 deductible lmao.

[Buizel]

THANK YOU for explaining like I'm 5 years old. I'll just go with the Aetna one, and hope it works. I had Aetna before (though the deductible &OPM was a lot lower...but that's what happens when you go from big corp to non-profit). I just got spooked cuz I didn't see Allied on any of my docs insurance lists but they do have Aetna.
I don't really have a choice but this one.., and you're right, I do not feel like dealing with the fluctuating negotiation prices each time. I am glad that the specialists are just a small copay. The ones on the marketplace didn't cover anything with like $9,000 deductible lmao.

Happy to help! As for the "Allied" part, it's probably an internal plan term or a 3rd party that Aetna may use. It's like the Open Access part of a plan, it's not something that a provider opts in or out of. It's something decided by the plan sponsor and/or health insurance as a way to provide extra benefits for a plan. For example, the OA part of a plan can sometimes waive referrals for services, which helps everyone in the process.

The Allied may be like that, or they just meant that that health plan option is just simply partnered with Aetna. Of course, the provider can get that answer when they call in a benefits check for you.