Blue Shield of California

by John Hansen

TRIO is Blue Shield of California’s aim at providing an affordable, high quality managed care product. It is an HMO, so the primary care physician (PCP) serves as the gateway to specialists in an effort to lower costs.

Blue Shield Covered California aims to get every patient to do an initial visit with their PCP to get their checkups. Or, as Renee Casserly, Director of Sales Operations and Business Development at Blue Shield of California, says “to get their tires checked.”

With the TRIO product, Blue Shield expects to compete with Kaiser Permanente. Top officials at Blue Shield fully admit that Kaiser is doing a lot right. They understand that Covered California Kaiser plans have a strong brand, and they are looking to similarly build a strong, trustworthy brand.

Kaiser Permanente’s integrative model with their one-stop shop with doctors, specialists, etc. all under one roof has been very appealing to many Californians. Many consumers in the state have gotten to the...

by John Hansen

When the Affordable Care Act was passed, Blue Shield Covered California hit the pause button on brand building. They focused their attention on Health Care Reform and being ready for the radical changes in the market. In so doing, they road on their reputation as it was previously established and stopped working on building their brand.

After Obama Care California was passed into law in 2010, Blue Shield turned their focus almost completely to getting ready for the implementation of Health Care Reform. According to Renee Casserly, Director of Sales Operations and Business Development at Blue Shield of California, this leading California carrier planned for three years, worked on their systems for 18 months, and spent tens of millions of dollars getting ready for 2014. They wanted to do well in the new world of Health Care Reform and they wanted to succeed in the Covered California exchange market.

With the busyness of transformation and adaptation, brand identity was almost...

By Wendy Barnett

Early in January, Blue Shield of California announced that they signed a new 3-year agreement with Sutter Health effective January 1, 2017. This is great news as it allows Sutter Health Hospitals and doctors to remain a part of Blue Shield’s network across the state.

Blue Shield of California members can now rest assured that their Sutter Health doctors and hospitals will still be considered “in-network” providers through 2019. Using in-network providers helps consumers save money. Even with a PPO plan where you can go out-of-network when desired, if you choose to stay in-network, you will have lower costs (think less co-insurance, lower deductibles, and lower out of pocket maximums).

Blue Shield Covered California plans will also continue to have Sutter Health as a part of their network. In certain areas, Blue Shield is sometimes the only insurance company that offers a PPO plan through Covered CA. Many Covered CA members desire the flexibility of having a PPO pl...

by John Hansen

The Blue Shield of California dental plans offer a variety of benefits and services for adults and children enrolled in their Medicare Supplement plan. Unlike other carriers, Blue Shield Dental Insurance California offers unique dental PPO plans. This allows patients to visit dentists within the Blue Shield of California network along with limited coverage from dentists outside their network.

Two types of DPPO plans are available through Blue Shield.

Currently, the PPO plan costs $37 for an individual, but from April 1st, 2018, the rates will be as follows.

With any of these plans, you may visit any dentist you want. But your out-of-pocket expenses will be much lower when you visit a dentist that’s part of the Blue Shield provider network.

Call us now for a free quote on all Blue Shield dental plans. We provide additional guidance on how to choose dental and health plans from any of the top health insurance companies in California.

by John Hansen

In 2017, Blue Shield will be adding a Silver Insurance Plan to their Covered California for Small Business (formerly SHOP) plan offerings. Consumers have been frustrated that Shield has not included a silver health care plan on the California Exchange for groups. It has made SHOP less appealing, and it has made Blue Shield less attractive to consumers considering enrolling in group health insurance for California through the State Exchange.

With 63% of consumers choosing silver insurance, these plans have been the most popular in the market. Whether people went with Covered California Blue Shield or with another carrier, the silver health care plan was most often the plan of choice.

Many small businesses were a bit disenchanted with the California Health Exchange when they found out there was no Blue Shield silver insurance plan offered. This often led them to go with another carrier (like Anthem Blue Cross) or to purchase coverage outside of the California Health Exchang...

by John Hansen

In 2015, Blue Shield, California’s largest non-profit health plan, acquired “Care First”. Currently, the medical insurance carrier is working to integrate Care First into the company.

For adults that line is at 138% of the Federal Poverty Level (FPL). When the household income goes above 138%, the adult consumer qualifies for a Covered California plan with a subsidy. When the income goes below 138% of FPL, the consumer qualifies for free or cheap health insurance coverage through Medi-Cal.

For children the FPL line is at 250% of FPL, and for pregnant women who get AIM (Access for Infants and Mothers) the line is at 300% of FPL. For a family of three with a pregnant mother, all three Federal Poverty Lines may apply. And, when income fluctuates, you can see how it becomes an absolute nightmare to keep track of which family members qualify for Medi-Cal and which ones qualify for Covered CA at any given time.

Care First was designed to manage the “Toggle Market,” which...

by John Hansen

Blue Shield of California knows that dropping grandfathered plans is not the most popular thing to do. It goes against the spirit of the Affordable Care Act (ACA). It makes consumers angry. People instantly hear echoes of the Obama Care promise, “You will be able to keep your current plans.”

But will I? Well, maybe. Yes, you can keep your current Blue Shield plan. That’s true as long as the California health plan keeps offering your grandfathered plan. If they terminate the plan, then you’re out of luck.

Blue Shield of California has lots of older, grandfathered plans that maintain very little enrollment. Some of these Blue Shield plans have less than 50 people currently on them. It becomes very difficult and costly for the medical insurance carrier to manage an excessive amount of health plans that have very few members.

The carrier has made the decision to terminate all grandfathered Blue Shield plans that currently have under 200 people on them. To see if your gra...

by John Hansen

Blue Shield of California calls the new plan “Trio”. This will be an ACO plan. ACO stands for Accountable Care Organization. This health benefits package will operate much like an HMO, and it might even be labeled an HMO. Top Blue Shield representatives said they were unsure at this time whether or not it would get the HMO label. However, they seemed certain that this plan would help them compete with California’s top HMO, Kaiser Permanente.

The Trio ACO plan will have a Primary Care Physician (PCP). This PCP will act as “gatekeeper”, just like on a typical HMO. A health plan member will need to see their doctor first and then get a referral in order to see a specialist. That means the California health insurance plan gets to do more babysitting, and they can make sure their clients get their checkups and labs done.

Blue Shield expects to offer comparable or even better pricing than Kaiser Permanente with their Trio ACO plan product line. They will include compe...

by John Hansen

June 2016, Blue Shield of California is mandating that all health insurance brokers selling their plans sign up to receive their commissions by Electronic Funds Transfer (EFT). This will help lower operating costs for this California health plan that is fighting hard to compete with Anthem Blue Cross and Kaiser Permanente.

Due to the implementation of Obamacare in California, Medical Loss Ratios (MLR) have to be at 80%. This means that the expenses for health plan administration, marketing and health insurance broker commissions cannot exceed 20%.

Blue Shield has many agents that get monthly commission checks, often of $20 or less per month. Now, the health plan will no longer be sending paper checks. Requiring EFT deposits for all their health insurance brokers will improve their efficiency and save them quite a bit of money in the administration department.

Quality of care, efficiency and affordability have been some of the key goals of the Obama Care program. California...

by John Hansen

Anthem Blue Cross and Blue Shield of California are leading the way when it comes to transparency regarding the cost of various health care procedures. They are now providing online tools where consumers can look up various health care procedures, see average costs, and view mortality rates. This helps California consumers in two primary ways.

When your doctor or surgeon tells you a procedure is going to cost X amount of dollars, you can respond intelligently. You’ll know whether or not your medical provider is offering you a reasonable price.

In the past, health plan members often took their physician’s word for it, not having any way to know whether or not the price was affordable. Now, consumers can check average costs ahead of time. They can haggle for a better price, or they can vote with their feet and go find someone who will give them an affordable price.

Mortality rates are worth checking. If you have a 15% chance of dying on the operating table, that may make...