Blue Cross Health Insurance-Coverage Considerations

There are several different types of health care insurance plans available. Some of which include HMO (Health Maintenance Organizations), and PPO (Preferred Provider Organizations). Blue Cross Health Insurance, and Blue Shield are the traditional type health insurance offered by mutual and stock companies.

Commercial insurance companies generally provide broad healthcare coverage, and are not really cost effective, or extremely efficient when delivering health care to patients.

However, Blue Cross Health Insurance differs in several ways when compared to other types of commercial insurance companies. One major difference is that many of their benefits are provided not on the basis of reimbursement, but rather on the basis of service. What does this mean? Rather then you paying the service provider and then being reimbursed by the company, Blue Cross Health Insurance pays the service provider directly for your treatment and services.

Blue Cross also establishes and maintains contractual relationships with doctors and hospitals. What this means is that in order for doctors and hospitals to participate with the Blue Cross Health Insurance plan, they must enter into a contract with the company. This contract defines the costs for the specific services provided to patients.

Blue Cross and Blue Shield are familiar names to most people. However, most do not understand that they are two very different types of health insurance. For all covered hospital services, Blue Cross Health Insurance is the plan to choose. For all covered physician services, it is Blue Shield. Blue Cross contracts with hospitals, Blue Shield contracts with physicians.

Blue Cross Health Insurance and Blue Shield are pre-paid health insurance plans. How this works is that you are required to pay a monthly premium to the insurance company in order to be covered for your medical services.

As a subscriber of Blue Cross Health Insurance, the hospital will be paid for each medical service claim provided. Generally, covered services would include pre-admission tests, chemotherapy, dialysis, physical therapy, diagnostic tests, emergencies, injuries, and minor surgeries. Specialized coverage for subscribers may be provided for families with dependent handicapped children. Additional coverage to include maternity benefits will also be available to subscribers.

Blue Cross may also offer supplemental coverage for catastrophic loss under the plan. Blue Shield, will handle coverage with your physicians. A Blue Shield participating physician will be paid directly 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 as well as comparable rates being paid to physicians in the same area. Together, Blue Cross Health Insurance and Blue Shield are a consolidated company, and should be considered when looking for quality health insurance coverage.

Copyright ©2006 Carl DiNello

Carl DiNello is an Article Author whose articles are featured on websites covering the Internet's most popular topics.

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