Often a prospective client will come to my office and request to compare their current health plan with other options. When I ask about their current coverage, they will respond, “I have Blue Shield” or “I have Blue Cross”, clearly assuming that all Blue Cross or Blue Shield plans are the same.
It’s a common misunderstanding. The first question we ask is whether or not the coverage is issued in California. Insurance is regulated by the individual states. If someone moves from OR for example, they may have coverage through Regence Blue Cross Blue Shield of Oregon, which is a different carrier from the “Blues” in California.
In fact, the original Blue Cross started in 1929 as a prepaid hospital plan allowing participants to prepay 50 cents a month for up to 21 days of hospitalization annually. Similarly prepaid physician or medical coverage for Pacific Northwest loggers was the start of Blue Shield.
In California the Blues continue as entirely different companies. Blue Shield of CA is a not-for-profit mutual benefit company (Corporate Name: California Physicians’ Service). There are no stockholders to satisfy. Blue Shield Life is a wholly-owned subsidiary of Blue Shield of CA.
In California, Anthem Blue Cross is the trade name of Blue Cross of California. WellPoint Health Networks Inc. and Anthem, Inc. merged in 2004. In December 2014, WellPoint, Inc. changed its corporate name to Anthem, Inc.
Anthem, Inc. is one of the largest health benefits companies in the United States. Headquartered in Indianapolis, Indiana, Anthem, Inc. is an independent licensee of the Blue Cross and Blue Shield Association serving members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Anthem, Inc. is a for-profit publicly traded company.
While corporate ownership is interesting, the more important issues for consumers is to understand the products offered by the companies. They are broken into specific markets:
Plans are segmented by the offerings: Individual and Family (IFP), Medicare, Small Group for employers with less than 100 employees and Large Group for employer groups with over 100 employees,
One very important basic difference within these plans are the provider networks underlying each of the products. As the insurance companies attempt to stratify the offerings and provide different pricing options, they will negotiate different provider contracts and identify those groups of providers under different network names. In fact, if you look at the “provider search” website for Anthem, your first identifying question will include 8 choices of plan offerings. Then you can choose from over 70 Plan/Network options. For Medicare plans there are about 35 choices.
So simply looking up your doctor on the provider’s website takes some guidance. We give our clients a cheat sheet with screen shots to assist them in search providers. One cannot simply ask their provider, “Do you take Blue Cross or Blue Shield?” Rather you must be very specific on the network name.
Further we caution our clients that even if the doctor shows up on the website, it’s a good idea to verify with the provider that they actually accept the plan. Sometimes the sites are not updated, despite the CA regulation that requires them to be updated regularly. Anthem states that they update the site weekly, but that doesn’t mean it’s 100% accurate.
To further complicate matters, the providers may not understand the differences in their contracts with the providers. For the most part, the Anthem contracts require provider to participate in most all of their networks. Yet, we consistently hear of providers that say they don’t take Covered CA, when they have an active Anthem contract.
One analysis of the Anthem Select network shows that it includes about 85% of the Anthem full Prudent Buyer network, so there could be surprises for an employer that purchases a “Select” plan. These network distinctions are important for buyers, whether employers or individuals. Once the decision is made to purchase the plans, then it is critical that the participants understand the nuance. It’s not a simple, “I have a Blue Plan”.
If an employer has out of state employees, it is important to assure that the plan includes the “BLUE CARD”. If so, there is reciprocity among Blue Cross/Blue Shield member companies in different states, thus protecting out of state employees.
Back to the original question of comparisons. Your benefits may be very different from others, so don’t assume! Understand the benefits as well as the underlying networks for the plans.