Do you have copayments with with Anthem?

Question

I pay $316/month for an individual plan and it shows in my benefits booklet that prenatal and maternity care is paid in full (until delivery which is 30% of total cost). Today I got two explanation of benefits saying that I owe my provider a $45 copayment for my first appointment and $160 for my lab work. Did I miss something?

Are the rest of you with anthem blue cross PPO paying a copayment for every visit?

I thought under the affordable health care act this fell under preventive care?

I'm calling tomorrow but I'm just so exasperated!

Note: If you live in a country with universal health care, I'm really happy for you. If you can, please resist leaving a comment that says something like "I can't believe how much you Americans pay for basic health care yada yada yada" I can't believe it either and it's super depressing.

Answer

Phew! After 3 hours on the phone it's been sorted out. So all prenatal care under my plan and the AHA will be covered without copayment. It just depends on how the office codes it and they can resubmit the first appointment to be prenatal. I'll only pay a % for genetic testing and the delivery.
Given the mixed responses I got I'm guessing it varies by plan or state? I'm in California which seems to be really embracing Obamacare and the women's health initiatives.

Between this and maternity leave our country is so far behind our European and Canadian counterparts.

Answer

Call and ask. Sometimes a bill that seems wrong is just a billing error.

Answer

I don't have copays when I go to my monthly visit but my limited understanding is that the copays I would make are bundled up with a big bill I'll get at the hospital. That bill caps at a certain amount but it's more than our combined monthly salary. We are prepared for it but you'd think insurance would make a bigger difference.

Answer

The first visit technically isn't a maternity visit. It's just to confirm pregnancy, so that is correct. But everything else should be covered until the delivery. Save, save, and save! 30% sure can add up!

Answer

I don't have anthem, but a different BCBS policy. I also have a secondary insurance, but just started using both this year.
Prior to that, I would have a flat co-pay for appointments, and then labs are covered by a percentage, except for wellness labs at a yearly physical. What I paid for labs would go to meet a deductible. I haven't seen any insurance available that would pay for maternity care 100%, except maybe Medicaid, so enrolled in double coverage when we decided to start TTC last year.

Answer

You always have a co-pay for your first visit to confirm pregnancy, after that your visits fall under pre-natal coverage.  All 3 of my pregnancies worked this way.

Answer

I have to pay a $60 copay when I have an u/s because they consider the dr. Who performs it a "specialist"

Answer

You're correct. Under the ACA, prenatal care should not have co-pays. Maybe call them and ask?

Answer

Well here's another thing that's frustrating about the health insurance here in the states- insurers work with companies to customize their HMO and PPO plans. So not everyone with an Anthem PPO has the same coverage that you do. I can't believe that people think this is a better system than universal coverage, but that's a different issue.

Answer

The pregnancy is covered in full, but you are still responsible for all co-payments as well as your co-insurance amount. You actually still have to pay your co-payment even after your max out of pocket has been reached. The pregnancy itself is fully covered but you still have to pay out of pocket...

Do you have copayments with with Anthem?

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