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Please please help! Horizon Bc/BS EPO Plus

post #1 of 11
Thread Starter 

Does anyone have this plan? Are you getting billed for prenatal services with in-network providers? I cannot seem to get a straight answer from the insurance company. All they keep saying is that I am responsible for anything beyond $500 in diagnostics. I far surpassed that with my first visit's bloodwork.

I am very worried I will get a huge bill at the end of all of this. If anyone knows ANYTHING about this...please let me know.

post #2 of 11
Yikes, that seems crazy! I have the same plan and it says pregnancy is fully covered so tests should be as well. Secondly, I had a different deductible plan through them during my last pregnancy and when I had to pay for a test I had to pay at the rate that it would have cost insurance, so $300 tests ended up costing $25, so I wouldn't panic to much yet. Are you sure your care provider is using correct billing codes?
post #3 of 11
Thread Starter 
I have yet to receive an EOB....so I have no clue. They quoted a vaginal ultrasound at $375. They told me $500 does not cover much. My book says pregnancy is not covered, but online it says it is. Very confusing!! I am hoping you are right!! Have you had a lot of prenatal care on this plan so far? Thank you so much....you are 1000 times more helpful than the insurance company!!!!
post #4 of 11
I just got my bfp a couple of days ago so I haven't used the EPO Plus yet but I just double checked and it says $30 first appointment then covered for pre and post natal and $500 for the hospital. I will have an absolute fit at them if they don't honor that. The whole reason I picked the stupid plan was because I wanted maternity coverage. I will say dealing with them before I had to call continuously to get things worked out and some people know what they are talking about and others have no clue.
post #5 of 11
Thread Starter 
Congrats!! I pay $30 each time I see my ob. There is a breakdown for the hospital stay that says roughly $720...so not a huge difference. The diagnostics concerns me most as they keep reiterating $500 max regardless of prenatal/in-network status. They paid $375 for one internal ultrasound. The last call I had the rep told me it was "not a good plan" and offered to transfer me to sales so they can upgrade me. I pay $388/month for my sub-par plan.

Please let me know if you hear anything else or know anyone on this plan who has experience with prenatal coverage.

Again....congrats!!!!
post #6 of 11
Thread Starter 
Quote:
Originally Posted by vtechmom View Post

I just got my bfp a couple of days ago so I haven't used the EPO Plus yet but I just double checked and it says $30 first appointment then covered for pre and post natal and $500 for the hospital. I will have an absolute fit at them if they don't honor that. The whole reason I picked the stupid plan was because I wanted maternity coverage. I will say dealing with them before I had to call continuously to get things worked out and some people know what they are talking about and others have no clue.

I posted this on another forum and got this reply:
serenity0227Pass a note Ignore userYeah I was afraid of that. Im a medical biller and get calls from patients who didn't understand a bill they received. My advice is always to read your benefits, find out what's covered and what's not. In your case, there's a $500 max on all lab/xray related services for pre- and post-natal services. Anything over that is your responsibility. You have one of those plans where the premium is lower but you also get limited benefits. Sorry.07/30/2013
post #7 of 11

I'm going to call them today and I'll let you know what happens.  None of it seems to make sense because everything I look at says something different and according to the booklet (vs the website), they don't cover ANY normal pre or postnatal care.  It does say they will cover complications, the delivery, and hospital stay.  I guess they might cover the first $600 of prenatal under their normal wellness care benefits, but that's it.  I had a major flip out over all of this last night but DH was meeting with his insurance broker this week anyway so he's going to ask him what options we have.  Right now we are thinking upgrading might be the best bet.  They have a deductible that would be about $125 more a month with a deductible of $2500 in-network, so about $3500 more for the year but if I have to pay for all pre-natal OOP, that is likely still cheaper.  ARGH, I am so upset over this! 

post #8 of 11
Thread Starter 
I got to the bottom of it this morning....not as bad as it looks!! Breathe....I am busy but will msg u later.
post #9 of 11
Thread Starter 
Ok so the $30 is per OFFICE VISIT
then you have $500/diagnostics and $600/ preventative, wellness

So...if your bloodwork is typically coded to preventative ...that is covered.
The diagnostics you do pay for anything beyond $500 w average u/s costing $250.

I called my dr who said they do not "balance bill" for bloodwork....basically they negotiate rates and take what the ins co gives them.

A urinalysis is like $4.00 ...so u get the pic.

The only one i am not sure of is genetic testing prices.

All of the above is available to you ASSUMING you have had no other tests/checkups etc this year.

So....ultimately we will pay for some things....but not everything.

Im foregoing the diabetes test and other genetic tests as mine was low risk. So i only have to cover a few more u/s and hep.

On a positive note, the hospital coverage is excellent!

I hope this helps.
post #10 of 11
So it's really just the diagnostics and the copay? Okay that isn't nearly as bad as it was looking. I can breathe again now, lol. Thanks so much for the info!
post #11 of 11
Thread Starter 
Yes ....like i said, the only open item I could not get a price for is genetic stuff. So....all in all WITH hospitalization we might have to cover 1k-1500 max. The important thing is that the bloodwork goes to the in-network labs and is the covered. I suggest you chat w your Dr to find out if they do balance billing....then you can be certain you are *mostly* covered smile.gif
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