Unlike other larger insurance companies like United Healthcare or Cigna, Blue Cross Blue Shield (BCBS) is a federation of insurance companies rather than one single entity. Collectively over 100 million people are covered under Blue Cross Blue Shield plans, more than any single insurance company.
Due to the structure of the federation, Blue Cross Blue Shield plans are typically localized to a state. In Oregon, Regence Blue Cross Blue Shield of Oregon is the local insurance whereas in in parts of Pennsylvania it is Highmark Blue Cross Blue Shield or Premera Blue Cross Blue Shield in Alaska. There are even states that have multiple BCBS plans with different networks! Due to this structure, the individual health plan will typically have their own network of participating providers listed within their locality.
To sort out this mess without having worry about any of it, reach out to learn more about our mental health billing service. We solve your insurance billing nightmare!
Out of State Plans
When the plans are localized in this fashion, it is inevitable that there is some messy crossover. Perhaps the subscriber lives in a different state from the insured. Or they work in a different state than they live. Or perhaps the client is simply traveling and needs services. There are countless reasons as to why a client may see a provider in a different state from their homeplan. So how is this handled?
An Example: You are a provider in Spokane, Washington and are in-network with Regence in Washington. But you have a client who lives nearby in Idaho and has a BCBS Idaho plan.
Blue Card Program
The Blue Card program was created to deal with this inherent restriction. According to Blue Cross Blue Shield IL, the Blue Card program is:
BlueCard is a national program that enables members of one Blue Cross and Blue Shield (BCBS) Plan to obtain health care services while traveling or living in another BCBS Plan’s service area. BlueCard links participating health care providers with the independent BCBS Plans across the country, and in more than 200 countries and territories worldwide, through a single electronic network for claims processing and reimbursement.
The Blue Card program is thankfully not an additional complexity to insurance billing, but a simplification. It essentially means, you can treat a client with an out of state BCBS plan like an in-network in-state one.
So Where Do I File Claims?
Thankfully, if you are a participating BCBS provider that sees a client with an out of state Blue Cross Blue Shield plan you do not need to know how to submit to all 36 different BCBS plans. Rather than having to worry about submitting to an out of state, all you need to do is submit to your local BCBS plan and they will forward the claim to the appropriate organization. You may receive a separate, different explanation of benefits for this client depending on how it is processed.
We take care of this with our billing service, if you want help.
Will I Be In-Network?
If you are are a participating provider in your local BCBS plan, you should be in-network for out of state BCBS plans according to the Blue Card Program. If you are not sure, you can call the Blue Card phone line at (800) 676-2583 and they will be able to forward your call to the appropriate insurance plan.
Eligibility & Benefits
One additional note is that the verification of benefits will still need to be conducted with the homeplan. For this reason, we highly recommend you get the front and back of the insurance card. The number on the back of the insurance card can significantly reduce the amount of time spent on the phone for eligibility & benefits as you’ll get in touch with the homeplan immediately.
If you wanted us to do this for you for free as part of our billing service, also happy to help! Hope this guide has been useful.