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Chapter 13

BlueCross BlueShield

QuestionAnswer
BCBS preferred provider networks health care facilities, physicians, and other health care professionals that contract with BCBS to provide members with accessible, appropriate, cost-effective, and quality health care services.
Blue365® provides members of certain BCBS organizations with discounts on health and wellness products and services.
BlueCard© program that allows BCBS subscribers to receive local Blue Plan health care benefits while traveling or living outside of their plan’s area, nationally, or in another country.
BlueCross BlueShield (BCBS) independent and local BCBS companies that provide health plan coverage to Americans in all 50 states, the District of Columbia, and Puerto Rico; coverage is also provided to those who live, travel, and work internationally.
BlueCross BlueShield Association (BCBSA) independent, community-based, locally operated BlueCross BlueShield plans that collectively provide health care coverage to more than 100 million Americans.
BlueCross BlueShield Global® health care plans for employers, individuals, and students who live, work, and travel internationally. It represents a collaboration with Bupa Global, which offers international health insurance plans to individuals at home or who live, study, travel, or
coordinated home health care coordination between inpatient facility and home health agency to facilitate patient discharge home; patient is provided with home health agency care by a participating provider
Federal Employee Program® (FEP) began covering federal employees in 1960, provides benefits to more than 5 million federal enrollees and dependents, and underwritten and administered by participating BlueCross BlueShield plans.
for-profit corporations pays taxes on profits generated by the corporation’s for-profit enterprises and pays dividends to shareholders on after-tax profits.
GeoBlue® international health care coverage for academic institution faculty/students/staff, employers, including non-profit organizations, individuals, and U.S. and non-U.S.
Government-Wide Service Benefit Plan phrase printed below the BCBS trademark on federal employee plan (FEP) insurance cards, which indicates that the enrollee has federal employer-sponsored health benefits.
health care anywhere concept that allows members of independently owned and operated BCBS health plans to have access to health care benefits throughout the United States and around the world.
members BCBS enrollee or subscriber.
member hospitals hospital that has signed a contract to provide services for special rates.
nonprofit corporations charitable, educational, civic, or humanitarian organization whose profits are returned to the program of the corporation rather than distributed to shareholders and officers of the corporation.
outpatient pretreatment authorization program (OPAP) also called prospective authorization or precertification; requires preauthorization of outpatient physical, occupational, and speech therapy services; acupuncture; spinal manipulation/chiropractic; and habilitative services.
service location location where the patient was seen.
usual, customary, and reasonable (UCR) description of amount commonly charged for a particular medical service by providers within a particular geographic region; used for establishing allowable rates.
Created by: Amaya122000
 

 



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