Blueshield Association: A Case Study

Improved Essays
BlueCross BlueShield

Terran Baumgartner
10/24/2014
HIMS 1410- Principles of Insurance
Instructor: Jazmine Konyek

BlueCross BlueShield Association (BCBSA) is a company that consists of more than 450 independantly, and locally operated BlueCross BleShield plans that give health care coverage to more than 80 million Americans. The BCBS is located in Chicago, Illinois, and establishes standards for new plans and programs, Assists local plans with enrollment activities, national advertising, public education, professional relations, and statistical and research activites. They are contractors for processing medicare claims, and coordinate nationwide BCBS plans. BlueCross BlueShield didn’t become a national association until
…show more content…
They cover Fee-for-service plans, Indemnity plans, Federal Employee Program plans, Medicare supplemental plans, and Healthcare Anywhere plans. Fee-for-service plans are what they would consider their traditional plans. The basic coverage covers hospitalization, obstetric care, newborn care, surgical feels, x-rays, diagnostic laboratory service, assistant surgeon fees, and intensive care. If you add the major medical coverage it will also cover office visits, outpatient nonsurgical treatment, allergy testing and injections, physical and occupational therapy, mental health encounters, prescription drugs, purchase of durable medical equipment, dental care, and private duty nursing. Indemnity coverage gives subscribers the benefit of using whatever health care provider they choose to use. They can choose between hospital-only or comprehensive hospital and medical coverage. Basically they have freedom to see whomever they want, whenever they want, without having to have a referral to do so. They also have many different coinsurance plans to choose from to help with the share of cost …show more content…
There are many different types of managed care plans. Some of the more popular types are preferred provider organizations (PPO), exclusive provider organizations (EPO), point of service plans (POS), and Health maintenance organizations (HMO). Health maintenance organization plans share the financial risks that come with having comprehensive medical services for a prepaid fee. Preferred provider organizations give cheaper health care with certain named providers. Exclusive provider organizations don’t have to have named primary care physicians but if they don’t go to the providers that are included in the plan they have to pay full price for whatever services they have had done. Point of service plans let you go to whatever doctor or hospital that you see fit, but under the understanding that they may have to pay a higher copayment for going to a physician or hospital that isn’t named specifically on their

Related Documents

  • Improved Essays

    Managed Care Case Study

    • 728 Words
    • 3 Pages

    There are main types of managed care plans: HMO, PPO and point – of – service. Health maintenance organization provides its members health benefits where individual have to pay monthly premium in order to use the benefits. In order the benefits to be covered by HMOs (unless it’s an emergency service) the patient must use health provider within the network. Copay may or may not be require for visit to health service provider.…

    • 728 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    Managed Care Disadvantages

    • 1092 Words
    • 4 Pages

    Managed care is the most prevalent form of health insurance plan that has significantly changed the ways that patients receive care and allowing them a variety of affordable care. Under managed care, health insurance plans have a contract with providers and hospitals to provide care for clients at lower cost. Clients who choose to enroll in a managed care plan should also be aware of both the benefits and the drawbacks of those care plans. Criticism/drawbacks Managed care health insurance plans, mostly the HMO 's, focus primarily on prevention, and people with these types of policies pay less for their coverage. The newest options in health insurance plans include the PPO (preferred provider organization) plans.…

    • 1092 Words
    • 4 Pages
    Improved Essays
  • Great Essays

    Medicare Part A Case Study

    • 1245 Words
    • 5 Pages

    Medicare (Title 18) is a program that provides health care to individuals who are 65 years or older, disabled, or suffer from kidney failure. Medicare has a basic four-part structure: Part A, which is hospital insurance, Part B, which is supplementary medical insurance, Part C, which is Medicare advantage, and Part D, which is prescription drug coverage. Part A and B make up what is known as traditional Medicare. Part A concerns hospital insurance, this is financed by payroll taxed through employers and employees. Part A pays for a portion of inpatient hospitalization, nursing care, home health care, and hospice.…

    • 1245 Words
    • 5 Pages
    Great Essays
  • Decent Essays

    Medicare comes in four parts. Some of the parts require payment, but the program isn’t based on a financial need. Part A covers the cost of being in a medical facility. Part B covers anything done to you in a medical facility. Part C is Medical Advantage, an alternative to traditional Medicare coverage.…

    • 110 Words
    • 1 Pages
    Decent Essays
  • Improved Essays

    Affordable Care Failure

    • 754 Words
    • 4 Pages

    The United States - The Patient Protection and Affordable Care Act (ACA) of 2010 established “shared responsibility” between the government, employers, and individuals for ensuring that all Americans have access to affordable and quality health insurance. However, health insurance coverage remains fragmented, with numerous private and public sources as well as wide gaps in coverage rates across the U.S. population. The Centers for Medicare and Medicaid Services (CMS) administers the Medicare program (a federal program for those age 65 and older and the disabled, including those with end-stage renal disease) and works in partnership with state governments to administer Medicaid and the Children’s Health Insurance Program (a conglomeration of…

    • 754 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    Healthcare Vs Medicare

    • 632 Words
    • 3 Pages

    Compare and contrast Medicare and Medicaid; including funding sources, fraud and/or abuse, and eligibility requirements for recipients: Medicare: A federal health insurance program for people who are 65 or older. Under 65 with certain / of any age and have End Stage Renal Disease (ESRD) or ALS. It is governed by the Federal Government and depending on the coverage you choose and may include: Care and services received as an inpatient in a hospital or skilled nursing facility (Part A) Doctor visits, care and services received as an outpatient, and some preventive care (Part B) Prescription drugs (Part D). (Part C)…

    • 632 Words
    • 3 Pages
    Improved Essays
  • Decent Essays

    here are several differences between Medicaid and Medicare, which are both federally funded health insurance programs. Medicare provides federal funded health insurance to people over the age of 65, dialysis patients and young disabled people. Medicare patients must pay a deductible and out-of-pocket expenses that are not covered. Medicaid provides federal and local funded health insurance for low-income families.…

    • 155 Words
    • 1 Pages
    Decent Essays
  • Improved Essays

    The type of insurance plan that I have is the PPO plan. PPO stands for preferred provider organizations and it is considered to be a loose-knit organization in which the insurers are contracted with the limited number of physicians and hospitals that agree to care for patients. This also includes the discounted fee-for-service basis with ultilization review (Bodenheimer & Grumbach, 2012). The total premium per month is not explain through the information given on the insurance card or my insurance account. As most people are familiar, the copays listed on their insurance card is the flat fee you would need to pay toawd services such as doctor…

    • 737 Words
    • 3 Pages
    Improved Essays
  • Superior Essays

    There are so many aspects to the healthcare field that affect the “Iron Triangle”. It is up to us as healthcare manager to know healthcare in and out so we can implement and decide what direction we need to direct our staff everyday.. We need to understand the impact modern medicine has, why healthcare cost is rising, what major issues we are facing, understanding Medicaid and Medicare and the current state of national health policy. If we were to change one thing it would have to be that there would be a cap on how things are charged so that people were not overcharged for something just because the doctor can. This would help the health care system so much in having a budget to plan for national epidemics.…

    • 1350 Words
    • 6 Pages
    Superior Essays
  • Improved Essays

    The similarities of both the HMO’s and PPO plans is that both plans require authorization, prior approval or pre-certification for many elective hospital admissions, tests which can be costly surgeries and procedures. Through the use of managed care, HMOs and PPOs are able to reduce the costs of hospitals and physicians. Managed care is a set of incentives and disincentives for physicians to limit what the HMOs and PPOs consider unnecessary tests and procedures. Managed care generally requires the consent of a primary-care physician before a patient can see a specialist.…

    • 1227 Words
    • 5 Pages
    Improved Essays
  • Decent Essays

    Some uncompensated care is financed by the private insurance through cost shifting like the hospitals are able to make up for the losses they might have incurred in treating…

    • 202 Words
    • 1 Pages
    Decent Essays
  • Great Essays

    My Discourse Community

    • 1352 Words
    • 6 Pages

    My discourse community is a group of scientists who understand a basic set of values and assumptions, and ways of communicating about the goals of being a Medical Laboratory Scientist (MLS). MLS like every healthcare profession requires someone with a big heart who not only shares in interest in the career, but whose main goal is to help people. There are specific fields related to a medical laboratory technician, such as, hematologist, immunologist, microbiologist, and blood banking. The healthcare system is an extremely large field with doctors, nurses and other medical staff.…

    • 1352 Words
    • 6 Pages
    Great Essays
  • Improved Essays

    Examples of a “fee-for-service” reimbursement are managed care and self-pay. There are a wide range of insurance companies that provide coverage at Memorial Sloan-Kettering. Some of the more common insurance companies that provide for and pay for services at MSK are Aetna, Blue Cross Blue Shield, CIGNA, HIP Medicaid, TRICARE, and United Healthcare. In addition to the various insurance companies that pay for services MSK also provides financial assistance for those without health insurance or to those individuals covered under an insurance that is not listed under MSK insurance companies (Insurance and Assistance,…

    • 783 Words
    • 4 Pages
    Improved Essays
  • Decent Essays

    In my opinion, a person covered by insurance (e.g blue cross and blue shields) should go to a participating (PAR) provider instead of a Non-Par. Going to a PAR provider will not incure any unnecessary medical expensive. PAR-providers are healthcare providers who have entered into an agreement with your insurance carrier. Therefore, using PAR providers protects an individual from having to pay for services which are not considered medically necessary or fees which are above what is considered to be usual and routine. I have also did some research about the issue of not having a PAR provider in the local area for an individual who have insurance.…

    • 238 Words
    • 1 Pages
    Decent Essays
  • Improved Essays

    Know the Vital Importance of Health Insurance People not plan to get sick however most people do need medical care at some point such as a lab test, counseling, a doctor visit or a prescription drug, etc. Emergency medical care or a surgery or even fixing a broken leg is very expensive procedures. For such issues people do need a health insurance that gives a high-quality coverage choice for both routine and non-routine medical services that is not only for you but for your family as well. People who have health insurance enjoy better access to prescription drug, get more preventive care, more able to pay for the necessities in life and hence lead a better health.…

    • 532 Words
    • 3 Pages
    Improved Essays