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Anthem SmartSense Review from Colorado

For most of my life, my health insurance has been provided by employer group coverage. But now I have a health plan through Anthem for my family, which includes myself, my husband and two small toddlers. The plan is called SmartSense which is more cost efficient and provides more freedom to choose from a variety of doctors and hospitals. With my Anthem plan, I have been able to keep my obstetrician that I have been seeing for five years and my children can keep their pediatrician that they have been seeing since birth.

I love having an individual family plan rather than my HMO because if and when I leave my current employer, my coverage goes where I go, and there is no 90-day waiting period as a new employee. Although I wasn't able to get maternity coverage, my monthly premium is only $339 a month for the SmartSense 5000 PPO. The cost is about $440 cheaper a month than my employer group HMO insurance. Our co-pays are just $10 more than my employer group would be. We each only get 3 visit’s a year but we are a pretty healthy family so we only need, and have used our insurance for sick visits and my toddlers' well baby care. In addition to that, I have used the coverage for special women's health needs that came about as a result of an annual women's exam. The best part about the co-pays and any other amount that I pay out of pocket, is that it all goes towards my deductible. However, a word of caution, if you have the extra money I would opt for a lower deductible. No matter how healthy you are. There are still some services that may not be fully paid as a result of not having met your deductible. For instance, my four-year-old and my two-years old, both had their physicals according to their respective ages, and some of the immunizations were covered but some other ones were not covered. So my patient responsibility (the amount that he insurance did not cover) was about $105 from the original amount billed, about $240. Again, the good news is the $105 goes towards my deductible.

Right now, I work for a community health clinic, so I would get vision services for a significant fraction of the cost of vision through Anthem, so I do not have vision coverage, and my family is covered under my employers group dental coverage. I am looking to get coverage with Anthem for dental as my premium will be about the same. By the way, as I mentioned I do Not have maternity and if I get pregnant I can Not add maternity. Insurance will not cover anyone who is already pregnant, although this may change with the new Obama healthcare reform.

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Overall, I think it is a great plan fro my family. We are saving over $5000 a year rather than having the HMO and having to drive all over Colorado to see a specialist.



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