What You Need to Know
Blue Cross Blue Shield is the largest health insurance company in the U.S.
It has 36 member companies. You’ll be a customer of the company that serves your area.
While most doctors accept Blue Cross Blue Shield insurance, some don’t, so check with your doctors before signing up.
No matter where you are, or what your age, your gender, or the size of your wallet, Blue Cross Blue Shield can provide a health insurance plan for you.
Who Is Blue Cross Blue Shield?
Blue Cross Blue Shield (BCBS) was launched in Texas in 1929 as an experiment in pre-paid healthcare.1 The company has grown exponentially since then, and now sells insurance in all 50 states, Washington, D.C., and Puerto Rico. More than 107 million Americans — one in three — are insured and managed by 36 independent and locally operated Blue Cross Blue Shield companies.2 More than 96% of hospitals and 95% of doctors and specialists accept BCBS health insurance.3 While some insurers operate with a tight number of network providers, that is rarely the case with a BCBS company.
These are all big numbers — more than any other insurer can boast.
BCBS started out as a nonprofit organization, but since 1994, the company has allowed its local franchises to decide whether to operate as profit-making or nonprofit companies. The conversion of some units to profit making has been controversial, but the organization has argued that a for-profit insurer can still be committed to providing affordable, accessible and high-quality healthcare.4
Does it matter whether your Blue Cross Blue Shield insurer is for-profit or nonprofit? A 2013 study by researchers at Northwestern University and the University of California suggested that there were no real differences in rates and that BCBS units that converted to for-profit status used some of their profits to improve the quality of their coverage.5 Plus, the Affordable Care Act (ACA) caps insurance profits and requires that companies rebate to customers any excess profits. In light of insurers’ profitability from the coronavirus pandemic, for example, customers may see a decrease in total premiums.6
What Health Insurance Does BCBS Offer?
BCBS offers a broad range of insurance. Each of its 36 entities can tailor its offerings to the needs of the communities it serves. BCBS Federal Employee Program serves about half of all U.S. federal employees, and Blue Cross Blue Shield Association National Labor Office sells insurance to 17 million union members. BCBS Global offers health insurance to Americans who work, live and travel internationally.7
These BCBS entities provide insurance policies for individuals and families including preferred provider organization (PPO) plans, health maintenance organization (HMO) plans, coverage for Medicaid participants, Medicare Advantage plans, Medicare Supplement insurance (Medigap plans) and Medicare Part D coverage of prescription drugs. Blue Cross Blue Shield companies also work with businesses of all sizes to offer insurance to their employees. In some areas BCBS sells short-term and supplemental plans like critical-care insurance. It offers dental and vision insurance almost everywhere in the U.S.
Accepted Almost Everywhere
More than 95% of doctors and 96% of hospitals in the U.S. accept Blue Cross Blue Shield health insurance.
How Do You Enroll in a Blue Cross Blue Shield Plan?
You can locate coverage on this website by typing in your zip code, or call 888-630-2583 and you’ll be transferred to a representative in your area who can answer questions, give you free quotes and help you sign up. You can ask about monthly premiums, deductibles and out-of-pocket costs.
Once you’re enrolled in your local BCBS unit, you’ll receive instructions for finding doctors and other healthcare providers. In general, healthcare providers will file claims for you. Many BCBS entities provide insurance customers with online portals that allow you to check the status of a claim. BCBS also offers an array of benefits, such as free nurse hotlines. In some areas, you’ll get access to Blue365, which offers discounts on a long list of products and services. Some of these are really good deals, such as deep discounts on hearing aids and dental care, even when your policy doesn’t cover these services.
In some areas of the country, BCBS customers have access to Blue365, which offers discounts on a wide variety of products and services.
How Is Blue Cross Blue Shield Rated?
Being able to trust that your insurer can afford to protect your health is the most basic of member concerns. That’s why you want to choose a financially strong insurer that will be able to provide consistently good service, including paying claims quickly. Unfortunately, there is no single rating of the financial strength of all 36 of BCBS’s separate insurance companies, but AM Best rates most BCBS entities. You can search here for the BCBS company you are considering. Or ask a BCBS company representative for its AM Best rating. The rep should be able to tell you — or get the answer. In general, the rating should be at least an A or, better yet, an A+.
While you are talking to the agent, you might ask how long it takes to get a claim paid. Insurance companies maintain that data and are usually happy to tell you, especially if they can brag that they pay 90% (or more) of their claims within 10 days, although most state insurance overseers give companies 30 days to act on a claim.
The percentage of in-network claims denied is also an important issue. Research on the 2019 denial rate among ACA insurers shows that denial rates of in-network claims ranged from 1% to 57%. Ask your representative to find out the company’s ACA claim-denial rate, or if you are comfortable working with data, you can search Kaiser Family Foundation files. 9
Another concern: how customer-friendly the BCBS insurer is that you are considering. State insurance departments regulate insurance companies doing business within their borders, and most provide an annual report that offers the number and type of complaints they received about those insurers. It also may offer customer reviews. Use this website to find your state’s office. If the information available doesn’t address your concerns, call the office and ask for what you need. State insurance companies exist to educate and protect citizens.
Alternatively, you can search for the company on the National Association of Insurance Commissioners’ website, where complaint reports are recorded.
You also can ask the Better Business Bureau (BBB) in your area. Search for “Blue Cross” in your Zip code. The customer service ratings and complaints lodged in the last year will pop up.
Strengths and Weaknesses of BCBS
Being a customer of the nation’s largest insurer is both a plus and a minus. In the plus column is the breadth of its coverage and the standardization of its services. You’re not likely to present your insurance card at a doctor’s office front desk and be told, “Oh, no, we don’t accept that insurance.”
Healthcare providers understand how BCBS does business. In general, they know what’s covered and what isn’t. For customers, that reduces the chance that the procedure you’re having won’t be covered or the drug the doctor prescribed isn’t on the approved list. And many doctors appreciate the speed and efficiencies of dealing with the big dog in the business because they get paid faster.
The negative is that BCBS is huge. If you have a complex question or your billing records are somehow screwed up, it can require patience to fix the problem.
- Find the BCBS company that serves your area.
- Compile a list of the coverage you want and need. Call and talk to a representative to narrow down your choices.
- Carefully consider the information the agent provides. Health insurance is complex. If you have questions, ask and get the answers you need before you enroll.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.