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Blue Cross Blue Shield Association, also known as BCBS, BCBSA, or The Blues, is a
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–based
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with 33 independent and locally operated BCBSA companies that provide
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
to more than 115 million people in the U.S. as of 2022. It was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, and Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948. Its headquarters are at the Aon Center at 200 E.
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in
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, Illinois. BCBSA claims to control access to the Blue Cross and Blue Shield trademarks and names across the United States and in more than 170 other countries, which it then licenses to the affiliated companies for specific, exclusive geographic service areas. It has affiliated plans in all 50 states, Washington, D.C., and
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, and licensees offering plans in several foreign countries; it also participates in the nationwide health insurance program for employees of the
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. BCBSA manages communications between its members and the operating policies required to be a licensee of the trademarks. This permits each BCBSA company to offer nationwide insurance coverage through its BlueCard provider network and claims reimbursement program even though it operates only in its designated service area.


History

Blue Cross and Blue Shield developed separately, with Blue Cross providing coverage for hospital services and Blue Shield covering physicians' services. Blue Cross is a name used by an association of
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
plans throughout the
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
. Its predecessor was developed by Justin Ford Kimball in 1929, while he was vice president of
Baylor University Baylor University is a Private university, private Baptist research university in Waco, Texas, United States. It was chartered in 1845 by the last Congress of the Republic of Texas. Baylor is the oldest continuously operating university in Te ...
's health care facilities in
Dallas, Texas Dallas () is a city in the U.S. state of Texas and the most populous city in the Dallas–Fort Worth metroplex, the List of Texas metropolitan areas, most populous metropolitan area in Texas and the Metropolitan statistical area, fourth-most ...
. The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally. The
American Hospital Association The American Hospital Association (AHA) is a health care industry trade group. It includes nearly 5,000 hospitals and health care providers. The organization, which was founded in Cleveland, Ohio in 1898, with offices in Chicago, Illinois and W ...
(AHA) adopted the Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960, the AHA commission was superseded by the Blue Cross Association. Blue Cross severed its ties with the AHA in 1972. Blue Shield was developed by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians. In 1939, the first official Blue Shield plan was founded in California. In 1948, the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans. In the 1960s, the U.S. government chose to partner with Blue Cross and Blue Shield companies to administer Medicare. In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS). Prior to 1986, organizations administering BCBS were tax exempt under
501(c) A 501(c) organization is a nonprofit organization in the federal law of the United States according to Internal Revenue Code (26 U.S.C. § 501(c)). Such organizations are exempt from some federal income taxes. Sections 503 through 505 set o ...
(4) as social welfare plans. However, the
Tax Reform Act of 1986 The Tax Reform Act of 1986 (TRA) was passed by the 99th United States Congress and signed into law by President Ronald Reagan on October 22, 1986. The Tax Reform Act of 1986 was the top domestic priority of President Reagan's second term. The ...
revoked the exemption because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation, but entitled to "special tax benefits" under IRC 833. In 1994, BCBS changed to allow its licensees to be for-profit corporations.Coordinated Issue Paper – Blue Cross Blue Shield/Health Insurance; Life Insurance: Conversion of nonprofit corporations
4 June 2008)
During 2010, Health Care Service Corporation, the parent company of BCBS in Texas, Oklahoma, New Mexico, Montana and Illinois, nearly doubled its income to $1.09 billion in 2010, and began four years of billion-dollar profits. In the final spending bill for FY 2015 after much lobbying since 2010, nonprofit Blue Cross and Blue Shield plans continue to have special tax breaks that were understood to be threatened by the
Affordable Care Act The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and informally as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presid ...
of 2010.


Current organization

Blue Cross and Blue Shield insurance companies are
licensee A licensee can mean the holder of a license or, in U.S. tort law, is a person who is on the property of another, despite the fact that the property is not open to the general public, because the owner of the property has allowed the licensee to en ...
s, independent of the association and traditionally of each other, offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every
U.S. state In the United States, a state is a constituent political entity, of which there are 50. Bound together in a political union, each state holds governmental jurisdiction over a separate and defined geographic territory where it shares its so ...
. They also act as administrators of Medicare in many states or regions of the U.S. The Blue Cross Blue Shield Federal Employee Program (FEP) is a nationwide option under the Federal Employees Health Benefits Program (FEHB) for U.S. federal government employees and retirees, and has been part of FEHB since FEHB's inception in 1960. FEP enrolls over half of the federal workforce, with over 5 million members, making it the largest insurer of federal employees and the largest single health plan group in the world. The association is headquartered in the
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complex in the
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area of Chicago, Illinois.


Multi-state member organizations

* Blue Cross Blue Shield of Michigan **Blue Cross Blue Shield of Vermont * CareFirst ** District of Columbia ** Maryland ** Parts of Virginia (Alexandria City, Arlington County, Falls Church City, and parts of Fairfax County) * Elevance Health (formerly Anthem) ** Anthem Blue Cross and Blue Shield *** Colorado *** Connecticut *** Georgia *** Indiana *** Kentucky *** Maine *** Missouri (excluding 30 counties in the Kansas City area) *** Nevada *** New Hampshire *** New York (eastern and southeastern counties) *** Ohio *** Virginia (excluding Alexandria City, Arlington County, Falls Church City, and parts of Fairfax County) *** Wisconsin ** Anthem Blue Cross (California) * GuideWell ** Florida Blue ** Triple-S Management (includes Puerto Rico and the US Virgin Islands) * Health Care Service Corporation ** Blue Cross Blue Shield of Illinois ** Blue Cross Blue Shield of Montana ** Blue Cross Blue Shield of New Mexico ** Blue Cross Blue Shield of Oklahoma ** Blue Cross Blue Shield of Texas * Highmark ** Highmark Blue Cross Blue Shield (Western and Northeastern Pennsylvania) ** Highmark Blue Shield (Eastern & Central Pennsylvania) ** Highmark Blue Cross Blue Shield Delaware (Delaware) ** Highmark Blue Shield of Northeastern New York (New York) ** Highmark Blue Cross Blue Shield West Virginia (formerly Mountain State Blue Cross Blue Shield) (West Virginia) ** Highmark Blue Cross Blue Shield of Western New York (New York) * Premera ** Premera Blue Cross Blue Shield of Alaska ** Premera Blue Cross of Washington * Cambia Health Solutions ** Regence BlueShield of Idaho ** Regence BlueCross BlueShield of Oregon ** Regence BlueCross BlueShield of Utah ** Regence BlueShield (Washington) * Wellmark Blue Cross Blue Shield ** Iowa ** South Dakota


Single-state member organizations

Single-state members include the following organizations. * Blue Cross and Blue Shield of Alabama * Blue Shield of California * Blue Cross and Blue Shield of Kansas City * Blue Cross Blue Shield of Massachusetts * Blue Cross Blue Shield of North Dakota * Blue Cross Blue Shield of South Carolina * BlueCross BlueShield of Tennessee * Capital Blue Cross (Central Pennsylvania) * Hawaii Medical Service Association * Horizon Blue Cross Blue Shield of New Jersey * Independence Blue Cross (Philadelphia, Southeastern Pennsylvania)


Arizona

Blue Cross Blue Shield of Arizona (BCBSAZ) is a non-profit healthcare organization founded in 1939. BCBSAZ partners with non-profit "Discovery Triangle Development Corporation" to launch a Farm Express mobile market (formerly Fresh Express).


Arkansas

Founded in 1948, Arkansas Blue Cross Blue Shield (ABCBS) is an independent licensee of the Blue Cross Blue Shield Association, and the largest healthcare provider in the state. It donated $1.98 million to The Walton College of Business toward founding its Robert L. Shoptaw Master of Healthcare Business Analytics Program. In August 2022, more than 12,000 members of Arkansas Blue Cross were affected by a ransomware attack on a former affiliate, North Highland Company, LLC.


Idaho

Blue Cross of Idaho and Regence BlueShield Idaho are separate companies and compete throughout the state.


Kansas

Blue Cross and Blue Shield of Kansas (BCBSKS) was founded in 1942 by Sam Bartham, later becoming an independent licensee of the Blue Cross Blue Shield Association.


Louisiana

Blue Cross Blue Shield of Louisiana is a tax-paying non-profit that was founded in 1934 in
New Orleans New Orleans (commonly known as NOLA or The Big Easy among other nicknames) is a Consolidated city-county, consolidated city-parish located along the Mississippi River in the U.S. state of Louisiana. With a population of 383,997 at the 2020 ...
. An independent licensee of the BCBSA, it is a privately held mutual company without shareholders, which is wholly owned by its policyholders.


Minnesota

Blue Cross Blue Shield of Minnesota (BCBSMN) was founded in 1933, with 3,500 employees reported in 2022.


Mississippi

Blue Cross Blue Shield of Mississippi (BCBSMS) was formed as a privately held company in 1954. In 1948, it was converted to a non-profit. In 1973, its name was changed from Mississippi Hospital and Medical Service to Blue Cross & Blue Shield of Mississippi, Inc., which, in 1996, was converted from a non-profit membership corporation to a mutual insurance company, with the name again changed, to Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company. During 2022, BCBS and University of Mississippi Medical Center (UMMC) network entered conflict over who is to blame for an increasing lack of covered care in the state. Media reported that UMMC had paid close to $279,000 for digital advertising, commercials, and billboards to attack BCBS, which, in subsequent months, sued the hospital for defamation. In December 2022, UMMC and BCBS reached a new contractual agreement.


Nebraska

Blue Cross Blue Shield of Nebraska was founded in 1939. On July 1, 2018, BCBS Nebraska formed GoodLife Partners Inc., a mutual holding company, to conduct its noninsurance businesses. The company retained the Blue Cross brand, converting from mutual ownership to a stock company wholly owned by GoodLife.


New York

Excellus BlueCross BlueShield (Excellus BCBS, or Excellus) is a
non-profit A nonprofit organization (NPO), also known as a nonbusiness entity, nonprofit institution, not-for-profit organization, or simply a nonprofit, is a non-governmental (private) legal entity organized and operated for a collective, public, or so ...
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
company headquartered in
Rochester, New York Rochester is a city in and the county seat, seat of government of Monroe County, New York, United States. It is the List of municipalities in New York, fourth-most populous city and 10th most-populated municipality in New York, with a populati ...
. It is part of the Blue Cross Blue Shield Association. In 2010, Excellus was
Upstate New York Upstate New York is a geographic region of New York (state), New York that lies north and northwest of the New York metropolitan area, New York City metropolitan area of downstate New York. Upstate includes the middle and upper Hudson Valley, ...
's largest nonprofit health plan. In 2001, Excellus merged with Univera Healthcare, (formerly North AmeriCare), based in
Buffalo, New York Buffalo is a Administrative divisions of New York (state), city in the U.S. state of New York (state), New York and county seat of Erie County, New York, Erie County. It lies in Western New York at the eastern end of Lake Erie, at the head of ...
. Univera retained its name and is separate from Excellus BCBS. Excellus was the target of a cyberattack in 2015, in which 10.5 million records were hacked, and cost the company 17.5 million dollars. The company's Blue Cross Blue Shield subsidiaries have been known as: *BlueCross BlueShield of Central New York *BlueCross BlueShield of the Rochester Area *BlueCross BlueShield of Utica-Watertown


North Carolina

By September 2010, BCBS licensee Blue Cross and Blue Shield of North Carolina announced that it would refund $156 million to their policyholders followin
documented
charges: they had been sued and fined for denying due medical treatments to their customers and for underpaying doctors. As of 2019 they were overseeing well over half of all payments for medical services in their state. BCBSNC invests in chronic and underlying condition research,
telehealth Telehealth is the distribution of Health care, health-related services and information via electronic information and telecommunications, telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminde ...
and
artificial intelligence Artificial intelligence (AI) is the capability of computer, computational systems to perform tasks typically associated with human intelligence, such as learning, reasoning, problem-solving, perception, and decision-making. It is a field of re ...
(AI) for digital healthcare. In 2019, Blue Cross and Blue Shield of North Carolina agreed to enter into a partnership with Cambia Health, but cancelled the agreement later that year. Dr.
Patrick H. Conway Patrick H. Conway (born 1974) is an American physician and an advocate of health system transformation and innovation in the public and private sector. He is a practicing pediatrician formerly serving at the Cincinnati Children's Hospital Medic ...
, who had served as CEO from 2017, was scheduled to become CEO of the merged company, replacing retiring Cambia CEO Mark Ganz, but resigned after a DWI arrest in June 2019, putting the merger on hold.


Pennsylvania

Though historically "Blue Cross" was used for hospital coverage while "Blue Shield" was used for medical coverage, today that split only exists for traditional health insurance plans in
Pennsylvania Pennsylvania, officially the Commonwealth of Pennsylvania, is a U.S. state, state spanning the Mid-Atlantic (United States), Mid-Atlantic, Northeastern United States, Northeastern, Appalachian, and Great Lakes region, Great Lakes regions o ...
. Two independent companies operate in central Pennsylvania, Highmark Blue Shield in
Pittsburgh Pittsburgh ( ) is a city in Allegheny County, Pennsylvania, United States, and its county seat. It is the List of municipalities in Pennsylvania#Municipalities, second-most populous city in Pennsylvania (after Philadelphia) and the List of Un ...
and Capital Blue Cross in Central Pennsylvania. In southeastern Pennsylvania, Independence Blue Cross in
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has a joint marketing agreement with Highmark Blue Shield in Pittsburgh for their separate hospital and medical plans. However, Independence Blue Cross, like most of its sister Blue Cross Blue Shield companies, cover most of their customers under managed care plans such as HMOs and PPOs which provide hospital and medical care in one policy.


Rhode Island

Blue Cross & Blue Shield of Rhode Island was founded in 1939. The insurer is headquartered in
Providence, Rhode Island Providence () is the List of capitals in the United States, capital and List of municipalities in Rhode Island, most populous city of the U.S. state of Rhode Island. The county seat of Providence County, Rhode Island, Providence County, it is o ...
.


U.S. Virgin Islands

BlueCross BlueShield of the U.S. Virgin Islands is administered by BlueCross BlueShield of Puerto Rico.


Wyoming

Blue Cross Blue Shield of Wyoming (BCBSWY) is a non-profit founded in 1945. In 2022, BCBSWY penned opposition to the Pharmacy benefit managers act enhancements (Wyoming Senate File 0036).


Companies outside of the United States

* Blue Cross Blue Shield of Costa Rica * Blue Cross Blue Shield of Panama * Blue Cross Blue Shield of Uruguay * Canadian Association of Blue Cross Plans * GeoBlue


Nonprofit status debate

While only some members retain nonprofit status, the ones that do have been criticized for holding excessive amounts of cash or excessive executive compensation. For instance, the CEO of BCBS Michigan, Daniel Loepp, earned over US$19 million in 2018, more than the CEO of Ford or Fiat Chrysler during the same year. In 2014, BC/BS of Illinois ( Health Care Service Corporation) was sued over its nonprofit status. The lawsuit was dismissed, with prejudice, and the dismissal ruling was upheld on appeal. Similar suits occurred with similar results in other states such as Oregon.


For-profit conversions

Conversions into for-profit corporations typically results in distribution of some of the assets into a
charitable foundation A foundation (also referred to as a charitable foundation) is a type of nonprofit organization or charitable trust that usually provides funding and support to other charitable organizations through grants, while also potentially participating d ...
. When Blue Cross of California was converted, it initially had no distribution, but subsequently The California Endowment and California Health Care Foundation were endowed with $3.2 billion. Proceeds ranged from $3.2 billion (California) to $1.5 million (Nevada). An exceptional case occurred in the Empire Blue Cross conversion, where the proceeds went to fund wage increases for union workers.


Antitrust settlement

In 2022, the group of 34 companies that make up the BCBS Association settled an antitrust investigation by allowing competition among member companies under non-Blue names while retaining regional exclusivity for regional licenses.


Claim denial controversies

In 2018, Robert Salim was diagnosed with stage 4 throat cancer, however, the
proton therapy In medicine, proton therapy, or proton radiotherapy, is a type of particle therapy that uses a beam of protons to irradiate diseased tissue, most often to treat cancer. The chief advantage of proton therapy over other types of external beam ...
ordered by his doctor was denied by Blue Cross Blue Shield. Salim sued. In July 2022 the United States District Court, Western District of Louisiana ruled that "Because Salim showed that PBT was a nationally accepted standard of care for advanced head and neck cancer in 2018, BCBSLA abused its discretion in finding Salim's PBT treatment was not medically necessary." A
ProPublica ProPublica (), legally Pro Publica, Inc., is a nonprofit investigative journalism organization based in New York City. ProPublica's investigations are conducted by its staff of full-time reporters, and the resulting stories are distributed to ne ...
investigation found that Blue Cross and Blue Shield of Louisiana used guidelines from an outside company called AIM Specialty Health to reject appeals for denial, and that this practice was widespread.


Surgical anesthesia denial

In August 2024, BCBS of Illinois, Texas, New Mexico, Montana, and Oklahoma changed their surgical anesthesia reimbursement policy to remove additional payments for medically complex patients, a move which the company said would streamline costs. This move was strongly denounced by the American Society of Anesthesiologists. In November 2024, it was announced that BCBS of New York, Connecticut, and Missouri would cease to cover the cost of anesthesia for surgeries which exceeded a time limit based on data from the Centers for Medicare and Medicaid Services, regardless of the time actually required for the surgery. Anthem argued that there was evidence of overbilling fraud by anesthesiologists, patients wouldn't have to pay if their operations went overtime, and that anesthesiologists could appeal for payment in the event that their operation went over the limit for out of medical necessity. The American Society of Anesthesiologists decried this move, calling it a “money grab” and “commercial health insurers looking to drive their profits up at the expense of patients”. This move was later canceled the day after the assassination of UnitedHealthcare CEO Brian Thompson which caused the policy to receive renewed backlash online, though there is no direct evidence linking either event to the cancelation due to backlash existing before the shooting. A week after the shooting, a woman in
Lakeland, Florida Lakeland is a city in Polk County, Florida, United States. Located along Interstate 4, I-4 east of Tampa and southwest of Orlando, Florida, Orlando, it is the List of municipalities in Florida, most populous city in Polk County. As of the 2020 ...
was arrested and charged after allegedly saying "Delay, deny, depose, you people are next" to a line representative after her claim was denied. The judge set her bail at $100,000, citing "the status of our country at this point".


See also

* Blue Cross Canada


References


External links

*
"How Much Is Too Much?
Consumersunion.org; July 2012.
"BCBSA History Fact Sheet"
Blue Cross Blue Shield Association; March 1997. * {{authority control 1929 establishments in the United States Companies based in Chicago Financial services companies established in 1929 Health maintenance organizations Insurance companies based in Illinois Medical and health organizations based in Illinois Organizations established in 1929 Supraorganizations