Blue Cross Blue Shield (BCBS) is known as one of the largest health insurance carriers in the nation, but Blue Cross Blue Shield is not an insurance company at all. It is a group of individual companies that joined together to contract with healthcare providers to provide care to its plan members.
Think of Blue Cross Blue Shield like one big umbrella, under which stands a host of different companies, all using the Blue Cross Blue Shield name. Some examples include:
Blue Cross refers mainly to plans for hospital services and outpatient care. Blue Shield refers mainly to plans for doctor’s services. In some states, BCBS is together as one company and in other states, like California for one, Blue Cross operates separately from Blue Shield.
So why does this matter?
In truth, this really does not matter at all because Blue Cross Blue Shield functions just like any other health insurance carrier. Some of these functions include:
Key features of BCBS
BCBS has numerous different plan designs from HMO to FFS and everything in between. They also administer some Medicare and Medicaid plans.
Blue Cross Blue Shield has an impressive provider network. It is hard to find a provider that is not associated with at least one of the Blue Cross Blue Shield plans. Providers who contract with BCBS plans, depending on the plan type, agree to provide care at discounted or contracted rates in exchange for access to more patients. Due to the fact that Blue Cross Blue Shield insures hundreds of thousands of lives, the expectation of having access to more patients may be realized.
In a nutshell
Blue Cross Blue Shield is most likely the carrier that you will work with the most often due to the number of members that have a Blue Cross Blue Shield plan.
Don’t be fooled into thinking that just because the name is the same that everything else is the same.
The name may be the same, but they are not a one-size-fits-all carrier. Every state could differ. The plans, processes and procedures could differ. The benefits, plans and coverages could differ. Take the time to verify coverage on all patients.
Unlike other health carriers, the member ID located on the patient’s ID card, with its alpha numeric numbering system makes it easy to tell at a glance that you are working with a Blue Cross Blue Shield Plan.
Subscribers are given a unique BCBS ID number that has a Plan-Specific alpha three-digit prefix, with up to 14 digits after - example ZAP123456789121. The first two characters of the prefix identify each plan and the third character identifies the type of product the subscriber is enrolled in.
BCBS also administers plans for employees of the federal government. Their ID cards for federal employees (FEP) do not have a three-digit alpha prefix. These ID numbers begin with the letter “R.”