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Blue Cross Blue Shield of Michigan (BCBSM) is an independent licensee of Blue Cross Blue Shield Association. [1] Currently it is headquartered in 600 E. Lafayette Blvd. in downtown Detroit. Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, provides and administers health benefits to more than 4.3 million members residing ...
The US government healthcare website defines usual, customary and reasonable as being "The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount."
Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state, and also act as administrators of Medicare in many states or regions of the United States, and provide coverage to state government employees as well as to federal government employees under a nationwide option of the Federal Employees Health ...
In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS). [11] Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance.
Millions of Medicare enrollees are likely to see relief in 2025 when a $2,000 cap on out-of-pocket prescription drug-spending goes into effect.
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In January 2016, Horizon BCBS announced their newest endeavor to improve care quality and lower costs through their Omnia Health Alliance. [citation needed] The new Omnia health insurance plans provide access to all of Horizon's network hospitals with some of them being designated as Tier 1 with greater cost savings for consumers.
Geographic Practice Cost Index is used along with Relative Value Units by Medicare to determine allowable payment amounts for medical procedures. There are multiple GPCIs: Cost of Living, Malpractice, and Practice Cost/Expense.