BCBS State Controversies and Governance Issues

BCBS state controversies and governance issues have been a topic of concern for many. Blue Cross Blue Shield of Michigan, for example, faced criticism for its handling of a major insurance company merger.

A 2019 audit found that BCBS of Michigan had overpaid its CEO by $1.5 million. This raised questions about the company's executive compensation practices.

Blue Cross and Blue Shield (BCBS) is a network of independent health insurance companies that provide coverage to millions of people across the United States.

BCBS plans typically offer a range of coverage options, including individual, group, and Medicare plans.

You can enroll in a BCBS plan during the annual open enrollment period, or during a special enrollment period if you experience a qualifying life event.

BCBS plans often have a network of healthcare providers, including doctors, hospitals, and pharmacies, that you can see at a lower cost.

Blue Cross Blue Shield (BCBS) State has a network of healthcare providers that includes over 90% of the state's hospitals and 80% of its primary care physicians. This extensive network gives members access to quality care from a wide range of healthcare professionals.

BCBS State has partnered with numerous health systems, including the state's largest hospital system, to provide members with access to specialized care. Members can visit the BCBS State website to find a provider in their area.

The BCBS State network includes over 30,000 primary care physicians and specialists, ensuring that members have access to the care they need. This network is constantly growing to meet the evolving healthcare needs of the state's residents.

BCBS State also offers a range of provider directories, including a mobile app, to help members find a provider that meets their needs. These directories provide detailed information about each provider's qualifications, specialties, and office locations.

Telehealth is a fast and easy way to see a doctor. State of Kansas employees with BCBSKS have access to virtual care services through their own network provider or Amwell. Amwell is convenient, affordable, private, and secure.

The cost per visit is the same as an in-person visit, making it a cost-effective option. Blue Cross provides telehealth services through Amwell, the industry's leading telehealth solution.

It's easy to use Amwell, with information available on their website. SEHP members also have access to telehealth through the HealthQuest Health Center.

Blue Cross Blue Shield has faced controversies in the past, particularly with claim denials. In 2018, a man named Robert Salim was diagnosed with stage 4 throat cancer and had his proton therapy denied by Blue Cross Blue Shield.

The court ultimately ruled in Salim's favor, stating that the insurance company had abused its discretion in denying the treatment. This case highlights the importance of having a clear understanding of medical necessity and the standards of care.

A ProPublica investigation found that Blue Cross and Blue Shield of Louisiana used guidelines from an outside company to reject appeals for denial. This practice was not isolated, but rather widespread.

In 2018, Robert Salim's proton therapy was denied by Blue Cross Blue Shield, despite being a nationally accepted standard of care for advanced head and neck cancer.

This is not an isolated incident, as a ProPublica investigation found that Blue Cross and Blue Shield of Louisiana used guidelines from an outside company to reject appeals for denial, a practice that was widespread.

A court ruling in July 2022 found that Blue Cross Blue Shield of Louisiana abused its discretion in denying Salim's proton therapy treatment.

The court ruling highlights the importance of patients having access to necessary medical care, and the need for insurance companies to follow established medical standards.

In another case, a woman in Lakeland, Florida was arrested and charged after allegedly threatening a Blue Cross Blue Shield representative, saying "Delay, deny, depose, you people are next" after her claim was denied.

The judge set her bail at $100,000, citing the current state of the country.

This incident highlights the emotional toll that claim denials can have on patients, and the need for insurance companies to be more transparent and fair in their decision-making processes.

The BCBS Association settled an antitrust investigation in 2022.

As part of the settlement, the group of 34 companies allowed competition among member companies under non-Blue names.

This move enabled member companies to operate under different names, while still maintaining their regional exclusivity for regional licenses.

BCBS State Governance is designed to provide a framework for decision-making and oversight. BCBS state plans are governed by a board of directors that includes representatives from the state's insurance department, the BCBS Association, and other stakeholders.

Each state's governance structure is unique, but they all have a similar goal of ensuring that BCBS plans operate in the best interest of their members. In some states, the board is comprised of a majority of public members, while in others, it's a mix of public and private members.

BCBS state plans are also subject to regular audits and evaluations to ensure they're meeting their goals and adhering to state and federal regulations. This oversight is crucial in maintaining the trust of their members and the wider community.

The School Employees' Health Insurance plan is administered by Blue Cross & Blue Shield of Mississippi, which handles claims processing, customer inquiries, and more. This plan is funded by the State of Mississippi.

You can contact the Customer Service Team at 1-800-709-7881 between 8:00 a.m. and 5:00 p.m. Monday through Friday if you have any questions about your benefits.

The Customer Service Team is available to help with any questions or concerns you may have about your health insurance.

If you're unable to reach the Customer Service Team by phone, you can visit their location in Flowood at 3545 Lakeland Drive.

Here are some resources to help you navigate your health insurance:

Some BCBS affiliates have been criticized for holding excessive amounts of cash, which can be a concern for their nonprofit status.

In 2018, the CEO of BCBS Michigan, Daniel Loepp, earned over $19 million, more than the CEO of Ford or Fiat Chrysler during the same year.

Critics argue that excessive executive compensation can be a sign of mismanagement and a lack of transparency.

BCBS of Illinois, also known as Health Care Service Corporation, was sued over its nonprofit status in 2014.

The lawsuit was dismissed with prejudice, and the dismissal ruling was upheld on appeal, setting a precedent for similar cases in other states.

Similar suits were filed in Oregon, with similar results, highlighting the challenges of regulating nonprofit status.

Single Member Organizations play a significant role in the BCBS state governance structure.

One of the key characteristics of Single Member Organizations is that they are single-state members. This means they operate in only one state.

For example, Blue Cross and Blue Shield of Alabama is a single-state member organization, serving the state of Alabama. Similarly, Blue Shield of California is another single-state member organization, catering to the state of California.

Here are some of the notable Single Member Organizations: