Blue Cross Health Insurance - Considerations When Purchasing Coverage

There are several different types of health care insurance available to you. Some of which include HMO, or Health Maintenance Organizations and PPO or Preferred Provider Organizations, which is a type of insurance created by physicians and hospitals specific for members. Another type is the traditional type which is mutual and stock companies such as Blue Shield and Blue Cross health insurance.

Commercial insurance companies generally provide broad coverage in the health area and are not really cost effective or efficient when it comes to delivering health care to patients.

There are several different ways that Blue Cross health insurance differs from other types of commercial insurance companies. One major difference is the fact that a great deal of benefits are provided not on a basis of reimbursement, but rather on a basis of service. In other words, instead of you paying the service provider then the company reimbursing you, Blue Cross health insurance directly pays the service provider for treatment and services rendered.

Another difference is the fact that this insurance carries relationships with doctors and hospitals through a contract. What this means is that in order to participate with that insurer, they must enter into a contract with the company, which defines the costs for different and specific services given to patients.

You have likely heard of Blue Cross and Blue Shield, but they are two very different types of insurance. For hospital services, the plan to choose is Blue Cross health insurance. When it comes to physician services, it is Blue Shield. With Blue Cross, a contract exists between the hospital and Blue Cross. With Blue Shield, there is a contract with the physicians and blue shield.

If you have ever heard of pre-paid insurance plans, you will understand what Blue Shield and Blue Cross health insurance is. If not, how this works is that you are required to pay the insurance company a premium each month in order to be covered for any medical services.

The workings of Blue Cross Health Insurance

When you are a subscriber of Blue Cross health insurance, the hospital will be paid for each claim made, when services are provided. Generally, under the blue cross plan services covered include pre-admission tests, chemotherapy, dialysis, physical therapy, diagnostic tests, emergencies, injuries, or minor surgeries. If families have handicapped children as dependents coverage might be provided, as well as maternity benefits to subscribers.

Catastrophic loss may be provided as well, as supplemental coverage under the Blue Cross plan. For Blue Shield, you are given coverage with your physicians. As a subscriber your physician will be paid directly to the physician as contracted and agreed upon. The amount paid, is pre-determined and is generally set on a basis of UCR (Usual, customary, and reasonable) rates. Furthermore, the rates will typically be comparable to the rates that other physicians charged in the same area. You have probably heard of Blue Cross health insurance and Blue Shield together as they are a consolidated company.

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