Blue Cross is effectively one half of the term of Blue Cross Blue Shield, and is one of those names that people readily known in terms of health insurance companies.
Its main value in some senses lies in its historical association with the nature of health insurance. Traditionally there have been Blue Cross policies and plans widely available throughout the United States, making it seem as if Blue Cross is a national insurance company.
Although Blue Cross policies have been available in most if not all states in America, they have always been wide variance as to the levels of insurance coverage and the range of benefits available – these have often differed quite widely from state to state.
Given the current range of healthcare reforms in America, Blue Cross policies are likely to be subject to even more changes and differing levels of availability in different states.
Blue Cross operates its insurance plans and health insurance policies fundamentally in the same way as other health insurance companies, although the costs and range of benefits will differ as in any market.
Health Insurance Market
If someone has not bought a Blue Cross health insurance plan before there are a few things that are worth bearing in mind. Blue Cross will operate all its health insurance plans on the basis of what is referred to in the health insurance market under two terms, that of prior authorisation and that of procedures being medically necessary.
Prior authorisation means in effect that before any procedure or intervention is carried out by any health care professionals that is likely to result in a claim under the policy, that the insurance company must agree to such a procedure or intervention taking place.
In addition, Blue Cross must deem that the health intervention or procedure is deemed what they refer to as a medically necessary. What this in effect means, is that Blue Cross, as is common with all health insurance companies, must agree any medical treatment before it takes place, and must agree that it is medically necessary in order to pay for the cost of it.
This in effect means that Blue Cross determines your medical treatment not you or your doctor or other healthcare professional. This is often a rude awakening for many people who have not experienced health insurance before, and can seem somewhat unfair.
In addition, this process often gives rise to a wide range of complaints, and a need for a quick disputes procedure both within the insurance company itself.
Often at a local level that will be specific consumer legislation giving policyholders a wide range of rights to affect the challenge decisions that have been made against them by health insurance companies that deny them treatment that they deem important for their health and well being.
