Blue Cross Blue Shield of Illinois is well known. Here is how this company saved Mark’s life. Not too long ago, the owner of MLD Agency, Mark Dupré found himself scheduling an appointment with urgent care as he was suffering from some severe pain. After scheduling the appointment, he received a call from his BCBS representative that went over his condition and his appointment needs with urgent care. Once they heard what was going on, they suggested he go directly to the ER based on his symptoms and the story. Mark did what he was told and believes that BCBS’s intervention saved his life.
Who is Blue Cross Blue Shield of Illinois?
An Insurance Carrier that Pays YOU Back?
Blue Cross Blue Shield is known as an insurance carrier giant and one of the most trusted carriers in the state of Illinois. The reason this company has been able to become the 950lb gorilla in the room is that it started right here in Chicago, IL in 1936. Back when it began no one knew it would turn into a national brand that not only pays out claims but even saves lives.
In 1936 BCBSIL was member-owned and remains member owned rather than being publicly traded. What does this mean for you? Well, it means as a member you are still part owner of this giant as you sign up for their benefits. You may not receive a cash payout or receive a certificate of stock ownership, but this large health organization has your health and well-being in mind.
Because they are not stock owned and a non-profit organization, they MUST spend 80% of their revenue from premiums on claims. This means when you and your other members do not have a lot of claims during a fiscal year, they have to refund YOU part of the premiums you have paid throughout the year. They are currently issuing refunds due to the recent COVID-19 pandemic of 2020.
Pay YOU back?? Yes, you read that right. Though they have paid premiums back in the past they have never seen such a large scale or refunds being produced since the recent COVID-19 pandemic. As the world shut down and elective surgeries and care were not deemed legally essential BCBSIL had a severe decrease in claims for 2020. As they continue to collect the same premiums from their members, they had a surplus in revenue and overpaid claims in the 2nd and 3rd quarters of 2020. 20% of the revenue is used to pay salaries, rent, and other overhead expenses while the other 80% MUST be spent on claims. If there are not enough claims each fiscal quarter a refund is to be dispersed to its member. If you are a BCBS customer, you probably have received a check or two already.
A Carrier with Your Health and Well-Being in Mind
Now that you understand who they are, including how their membership-owned and non-profit status affects their operations it is easy to see why customer care is one of their top priorities. They have built and maintained one of the best customer care and membership care programs in the US. As part of their commitment to you as a member and to keep themselves from contributory negligence lawsuits, they have a staff of Doctors and nurses that work for them and evaluate claims along with the recommendations of patient care before they pay out certain claims.
Let me tell you another story from the archives of the MLD where Mark sadly lost a client. This particular client was scheduled for surgery for lung cancer. While lung cancer surgery can be very risky this was not the reason the patient passed. The lung surgery went very well, and the patient was sent home, but the doctor prescribed the wrong medication after the surgery which ultimately led to the patient’s death. This is never something the MLD wants to get involved in, though it is the course of business. Our legal and ethical obligations led us to release all and any documents related to their insurance. Blue Cross Blue Shield refused to pay the claim for the medication that was prescribed by the Doc claiming they needed further evaluation and wanted to speak to the Doctor before paying this claim. The patient still picked up and took the medication and BCBSIL was not held liable for contributory negligence because they did not believe the patient should take the medication. As you can see this insurance giant may be a pain in the neck at times refusing to pay claims or wanting to speak with your Doctor before approving procedures or medications, but the reasons are that they are part of your care and the community that takes care of your health. Why not have a 2nd set of eyeballs on things that can be a matter of life or death? In this case, we wish the patient had taken the advice of their carrier, yet many wouldn’t go against an MD’s advice.
The Future of Blue Cross Blue Shield of Illinois
What are the most recent updates with BCBSIL? Well, we are proud to have seen their announcement to partner with one of the largest independent physician practices in the Chicago area, DuPage Medical Group. This partnership is an innovative value-based care model in which they will release more details as it rolls out. What it is hoping to achieve is better care for its members by means of offering reimbursements to physicians for providing the best care possible with specific services provided to patients. They believe this will be a game changer in ensuring fewer hospitalizations or major medical issues for their members.
There are many reasons why we at the MLD support and enroll hundreds of clients in Blue Cross Blue plans every year. We not only stand behind this age-old member-owned nonprofit because of its humble beginnings, but they have proven to really have patient care in mind.
Contact us for all your Blue Cross Blue Shield of Illinois needs.
Disclaimer: This is not an advertisement promoting the use or membership of BCBSIL. This is an interpretation of the company based on experience as an independent insurance agent.
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