Blue Shield Covered California
Blue Shield of California was founded in 1939 and is based in the heart of California in San Francisco.
A not-for-profit health plan, Blue Shield of California has over 3.5 million members. Covered California Blue Shield plans proudly account for 29 percent of CA State Insurance Exchange enrollees. And they are one of the only two preferred provider organizations (PPO’s) offering plans in all California counties and zip codes through the California Exchange.
Blue Shield of California was given the highest ranking status of “Excellent” by the NCQA (National Committee for Quality Assurance) after a voluntary review was done of how the carrier ensures its members, including those on Blue Shield Covered California plans, receive high quality care.
Blue Shield provides an extensive network with approximately 46,000 doctors and 300 acute hospitals for its members on a PPO plan.
2016 brought further expansion of coverage to all Yuba, Sutter, Alpine and Monterey counties. In addition Blue Shield has announced that it will replace its EPO (exclusive provider organization) with a PPO in the Central Coast, Northern, North Bay and Alameda areas. This will give more provider options for Blue Shield Covered California members.
Blue Shield of California offers it’s BlueCard program for PPO plan members. Blue Shield describes this program as “Linking Blue plans across the United States and abroad through a single electronic network for claims processing and reimbursement.”
In 2017 Blue Shield introduced the “Trio” Accountable Care Organization plans to Covered California. These ACO HMO’s will be using an integrated network delivery model across specialties and hospitals with the goal to improve quality patient outcomes with overall efficiency.
For the coverage year of 2018 the Blue Shield’s Trio HMO plans will expand into Solano, Contra Costa, Alameda and Ventura counties.
To preview Blue Shield’s provider network, please click here.
Blue Shield and Adventist Health have collaborated to offer Telehealth to its PPO members including those who have obtained coverage through a Blue Shield Covered California plan. This unique benefit allows members to access specialist care through the technology of telemedicine. What this means is that a patient can go to a convenient location where a telemedicine cart is equipped with a high-definition camera, diagnostic scopes, and vital signs monitor that can provide the specialist with accurate images and sound readings. An encrypted connection protects your privacy, and visits are a covered network benefits regardless of the clinic location. For members in remote locations this can be a win-win solution.
An online tool called the “Treatment Cost Estimator” is a way for Blue Shield Covered California PPO member’s to make good decisions for their healthcare by accessing treatment information for over 1600 procedures, 400 treatments and 160 episodes. This information along with physician consultation can offer added confidence as members navigate the often times complex medical world.