Blue Cross Blue Shield – Is this provider for more than 1/3 of the nation’s people a consistent and reliable provider of coverage?
Overall, the answer might be yes. “Might be” are the operative words here, as the company is a fairly complexly structured organization. The answer predominantly depends on which State you are being covered in. Blue Cross Blue Shield (BCBS for short) is actually an association of 39 independently operated entities that span across the United States. Think of it as a federation of localized companies of sorts. In speaking with different individuals and families around the country about the subject of health coverage, a good percentage of them are covered by BCBS.
My personal experience has been fairly satisfactory, probably in large part due to the fact that my present employer covers 100% of the benefits, which is not very common. So, from a strictly personal perspective I would rate BCBS as one of the better insurance providers on the market. The association has been in operation for close to 80 years and has become a nationally recognizable name in the health insurance marketplace.
The pros:
1. The centralized benefits and claims processing is fairly centralized and provides a consistent experience.
2. The online resources BCBS makes available are very informative, and finding a physician is very user-friendly.
3. Benefits statements are mailed routinely and coded to show why or why not procedures were covered.
4. BCBS appears to be a top choice for many employers and BCBS appears to provide many different incentives.
5. Comparatively, BCBS pricing is more affordable than others.
The cons:
1. The physicians that are part of the BCBS plans are not always a consistently decent experience. Some physician’s offices seem disorganized and may tell you that a procedure appears to be covered, only to find out later from BCBS that this is not the case. This could be viewed as a BCBS quality control issue perhaps.
2. When receiving treatment outside of your home state, the claims processing can at times become a bit of an administrative challenge. For example, I reside in the Chicago area and had an eye appointment in Michigan. At first the claim appeared to free and clear; however, a month later I received a letter stating it was improperly filed. The complexity had to do with my not being part of the Michigan coverage plan. This took many phonecalls to sort out and resulted in the claim being paid from my personal out-of-pocket expenses. Eventually, pursuing it further became a drain on my time and productivity.
3. The lower cost of BCBS coverage may be a root cause for some of the health care provider quality concerns that are mounting.
In summary, if we compare BCBS to the other national health care providers, they certainly do provide a good value for the money; however, BCBS is not at all immune to the national health care problems we face today. Both their PPO and HMO plans alike tend to face the same challenges with physician service quality as other coverage providers do. Comparing apples to apples here, BCBS is a good value, but do not expect perfection.