Blue Cross Shield comprises 34 independent companies that are locally operated and owned in all 50 states, including Washington and Puerto Rico. It was founded in 1929 by Justin Ford Kimball to provide its members with healthcare coverage and insights.
Their healthcare approach is personalized according to the needs of the communities where the members work and live. Blue Cross Blue Shield works closely with several community hospitals and doctors to provide affordable and quality healthcare.
They provide nationwide healthcare coverage that opens doors for millions of members in all 50 states, including Washington and Puerto Rico.
They have several health insurance plans on several levels and premiums such as bronze, gold, and platinum. BCBS is committed to providing access to affordable and high-quality healthcare coverage as well as enabling discoveries in the health sector.
Types of Plans Available on Blue Cross Blue Shield
BCBS offers three types of plans on the ACA marketplace; the three plans are listed and explained below:
HMO stands for Health Maintenance Organization; the plan covering in-network care by network providers.
This means they have doctors, specialists, and hospitals they have contracts with who provide health care services to their members.
These doctors and hospitals who have contracts with HMO are referred to as in-network, HMO typically accept only in-network care providers.
Another important factor about HMO is the fact that it requires its members to have a PCP which stands for primary care provider.
Members must receive referrals from their PCP in the event they need to get care from out-of-network doctors or specialists.
EPO stands for exclusive provider organization; this plan covers in-network care by network providers just like HMO.
This means they have doctors, specialists, and hospitals they have contracts with who provide them with health care services to their members.
The important factor here is that, unlike HMO, EPO doesn’t require a PCP or a referral if a member needs to see a specialist.
PPO stands for Preferred provider organization; this plan offers a lot of flexibility to its members by providing more than just in-network care providers.
They go further to allow their members get out-of-network care from other doctors and specialists not in contracts with them.
However, out-of-network costs more than getting care from in-network care providers which means the premium comes at a higher rate than any other plan.
the important factor to note here is that with the PPO plan, members do not require referrals before seeing a specialist.
Benefits of Blue Cross Blue Shield
BCBS comes with extra benefits as listed below:
- They provide an online account for members to view their coverage
- They provide an online account for members to find in-network doctors
- They provide an online account for members to manage and track their claims
- They provide an online account for members to submit fitness and weight loss reimbursements.
- They offer discounts on health, wellness, fitness, personal care, lifestyle services and financial health.
What is a Primary Care Physician?
A Primary care physician is a medical professional who is your first contact with a company’s health care system.
Your PCP knows your health history well and is also known as your care provider, personal care physician, or personal care provider.
If you desire to see a specialist, depending on the plan you choose, you may need to get permission from your PCP and proceed to get a referral.
What do I do when I am Denied Coverage?
There are two things to do when you are denied coverage, you can decide to access specific information about your coverage and claims by contacting the customer service number on the back of your membership card.
You can also find your local BCBS company online and access information relating to your group health insurance.
What are the downsides of BCBS?
The downsides of Blue Cross Blue Shield are few because BCBS is an amazing platform for health insurance, below are the downsides:
- They have a higher than usual premium at the ACA marketplace, their premium is higher than other competitors, however they provide excellent service.
- They have a slightly high compliant level
What is ACA Marketplace like in BCBS?
The BCBS marketplace is divided by metal tier which include the bronze, silver, gold and platinum plans.
Bronze and silver have the lowest premiums but also have the highest out-pocket costs, platinum and gold have high premiums but low and few out-of-pocket costs.
Bronze and silver are quite common and easy to get unlike platinum and gold plans which are fairly rare.