Other Free Encyclopedias » Online Encyclopedia » Encyclopedia - Featured Articles » Featured Articles: Blanco Kitchen Sink - Blanco Kitchen Sinks: More Than 80 Years of Quality and Innovation to Cherry Hill Inn - Find a Cherry Hill Inn and Get Close to Philadelphia

Blue Cross Blue Shield Hmo - Selecting a Blue Cross Blue Shield HMO

blue cross blue shield plans

Blue Cross and Blue Shield is the traditional, most recognized health insurance company in the United States. Blue Cross and Blue Shield is known for its indemnity health insurance policies, but they also offer Blue Cross Blue Shield HMO (health maintenance organization) coverage as well.

History of Blue Cross Blue Shield

Blue Cross and Blue Shield were started as two separate companies. Blue Cross provided insurance coverage for hospitals, while Blue Shield provided coverage for physician services. In 1939 the American Hospital Associated adopted the Blue Cross symbol as the industry standard for hospital plans. The first Blue Shield insurance plan was founded in 1939 in California. It wasn’t until 1982 that the two plans merged under the Blue Cross Association. Together they formed the Blue Cross Blue Shield Association.

Traditionally Blue Cross Blue Shield plans were 501©(4)non-profit social welfare plans. The Tax Reform Act of 1986 changed the designation to 501©(m) “special” tax benefit plans that were not tax-exempt. Blue Cross Blue Shield, in 1994, changed to for-profit corporations, though some plans are still non-profit insurance plans at the state level.

Blue Cross Blue Shield Plans

Today there are 39 separate Blue Cross Blue Shield plans operating in different states under the umbrella of the Blue Cross Blue Shield Association. The plans provide health insurance coverage to more than 100 million people. In each state the Blue Cross Blue Shield plan operates as an independent franchise. The largest Blue Cross Blue Shield plan is the publically-traded WellPoint, which provides health insurance coverage in 14 states.

Blue Cross Blue Shield Health Insurance Plans

Blue Cross Blue Shield plans are traditionally know for their indemnity, or fee-for-service, health insurance plans. With indemnity health insurance coverage, an individual can use any medical provider for services. The bill is then sent to Blue Cross and Blue Shield, and coverage is paid determined by the level of coverage of the policy. Indemnity plans usually have deductibles, copayments, and coinsurance amounts that the individual is responsible for paying.

Blue Cross Blue Shield HMO (health maintenance organization) plans are considered managed care insurance coverage. HMO plans provide comprehensive health insurance coverage through a network of providers contracted by Blue Cross Blue Shield. The network of medical providers includes physicians, hospital, laboratories, and ancillary care facilities that provide all medically necessary care to members of the HMO.
When a person joins an HMO, they agree to use the network of contracted providers, and in turn Blue Cross Blue Shield agrees to cover medical services. There is often a small copayment the person has to pay for receiving medical care from physicians.

Blue Cross Blue Shield HMO plans enter into contract with local medical providers. These contracted providers undergo an extensive credentialing procedure to ensure that they are in good standing in the community and with the American Medical Society. The provider’s backgrounds are thoroughly checked, including any outstanding malpractice claims, patient complaints, educational background, hospital privileges, and ethical standing among peers. Individuals joining the HMO either through their employer’s health insurance benefit plan, through an association, or on an individual level should feel comfortable that the providers on the HMO participating list deliver quality care.

Joining a Blue Cross Blue Shield HMO

The primary care physician that an individual selects upon joining an HMO becomes the gatekeeper of medical care. When an individual has a medical problem, the primary care physician is the first contact. If the individual requires the services of a specialist, laboratory work, or hospital admission, it must first be approved by the primary care physician. Through this system, there is always one provider who has a comprehensive picture of the individual’s total medical care and needs. Even emergency room visits for non-life threatening issues should be coordinated through the primary care physician.

Though it may seem restrictive, it benefits the individual in case of an emergency when one medical provider has a comprehensive medical history. And the cost savings are significant when an individual has Blue Cross Blue Shield HMO medical insurance coverage.

When considering joining an HMO, review the list of participating providers carefully. Chances are an individual’s provider will already be on the list, making the decision to save money on healthcare easy.

Blue Cross Louisiana - Quality Health Care with Blue Cross of Louisiana [next] [back] Blue Ash Hotels - Fantastic Hotels in Blue Ash, Ohio

User Comments

Your email address will be altered so spam harvesting bots can't read it easily.
Hide my email completely instead?

Cancel or