36 Blue Cross Blue Shield Health Insurance Companies Explained

Hello this is dr eric bricker and thank you for watching a healthcare z today we're going to be discussing blue cross blue shield organizations now if we're going to talk about health care in america we have to understand blue cross blue shield because according to their own website they touched like a third of americans.

So blue cross is a huge deal okay now why do i say organizations because there are 36 individual companies that are part of the blue cross blue shield association so the blue cross mission association is an actual thing it only has a thousand employees it's based in chicago they basically like.

Provide licenses or grant the license to be a blue cross member organization but then each of these 36 individual organizations are like their own legal entities okay now they all share a network meaning that if you have a blue cross employee that is in one part of the country versus another part of the country like.

They like share each other's network so it's all part of the quote-unquote blue cross provider network but in terms of each individual plan they're different okay so that's one thing that makes blue cross unique another thing that makes blue cross unique is that for the vast.

Majority of these 36 individual blue cross plans they do not compete with each other they have specific geographic boundaries where the companies that are domiciled within their geography only that particular blue cross plan can go after them and other blue cross plans cannot now.

There are some small exceptions to that which i'm going to go over however let's get started with the a number one biggest one which is anthem okay now anthem is also unique in that it is a for-profit company it is number 33 on the fortune 500 is publicly traded you could buy stock.

In anthem it has 92 billion dollars a year in revenue it has 64 000 employees it has 40 million members it is by far the largest blue cross plan now it has it's like the major like anthem blue cross plan in california it's not even called anthem in new york state it's called empire blue cross blue shield.

Also it's called blue cross it owns blue cross blue shield of georgia now anthem also sells planets in like uh connecticut and colorado so it's in a number of states as well so it is by far the 800 pound gorilla now next up is hcsc our healthcare services corporation now of course.

No one's ever heard of healthcare services corporation because it goes by its individual constituencies uh oh by the way it's non-profit so you can't buy stock in it it's not publicly traded it's a non-profit organization okay it's blue cross and illinois blue cross texas blue cross of oklahoma blue cross.

New mexico and blue cross and montana okay now all of these blue cross plans are part of the same organization hcsc so the same corporate entity even though in texas where we are yeah by blue cross and texas and if you're in chicago you'll buy a blue cross of illinois okay are you confused enough yet is your.

Head spinning yet we move on okay then there is highmark which is the blue cross plan for part of pennsylvania delaware and west virginia now pennsylvania is very unique in that guess what it not has it doesn't have one not two but it has.

Three different blue cross plans and sometimes so independence blue cross is in like the philadelphia area and capital blue cross is in like the higher harrisburg area but there are parts of the state of pennsylvania where a high mark and capital and independence actually compete with each other so you could have competing blue.

Cross plans now pennsylvania is highly unique in that respect so i'm not going to belabor the point but again it's complicated next up care first blue cross is for the district of columbia maryland and northern virginia next up is primera blue cross which is for the state of washington and alaska.

Next up is cambia but it's not really known in the market as cambia it's known by regents blue cross of oregon or idaho or utah or again in washington so there we have another overlap between primera and regions okay next up is well mark not to be confused with the high mark but well-marked blue cross.

Is in iowa and south dakota okay now you have all the individual state blue cross plans as well for like the remainder of the states and so it's just some highlighted names there like blue cross of alabama blue cross tennessee and then there's like blue cross at kansas city so there's a blue cross in.

Missouri there's a blue cross at kansas but then there's a separate blue cross at kansas city which only does the metro kansas city area on both the kansas side and the missouri side and again if you're a company that's domiciled in the kansas city area you go through blue cross kansas city.

Whereas if you're like in central missouri you go to blue cross missouri again are you confused yet it's a little complicated okay then finally we've got blue cross south carolina why do i bring up blue cross and south carolina okay they offer the blue cross.

Plan in their state but they also have a subsidiary that is called national alliance and national alliance actually acts as the back office for 11 out of the 36 blue cross plans and they tend to be these smaller blue cross brands what does back office mean that means.

They do the claims processing they do customer service so you think you have a blue cross plan of xyz state but when you call into customer service they might answer the phone blue cross of xyz state but they're actually a blue cross south carolina national alliance employee oh by the way they do case management.

They do disease management so essentially that blue cross plan that outsources its back office to national alliance they're essentially just a sales and marketing and customer uh client success organization because everything else is done through national alliance so blue cross blue shield is incredibly.

Complex but i wanted to share that with you today thank you for watching a healthcare z

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