Understanding Blue Cross Blue Shield

As one of the best-known insurance networks in the U.S., Blue Cross Blue Shield can look very similar on the outside to nationwide insurance companies such as Optum, Aetna, or Cigna. 

However, there is also a key difference: rather than being a unified national network, Blue Cross Blue Shield is a collection of 35 independent regional insurance companies. Each of these companies have their own contracts, local insurance networks, and relationships with the states they serve.

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This means that, if you want to see a provider who is in-network with Empire BlueCross BlueShield of New York, and you have an Anthem BlueCross BlueShield of New Jersey plan, your health plan may not be eligible — even though both plans share the same Blue Cross Blue Shield brand name and logo. 

How do I know if my Blue Cross Blue Shield plan is eligible?

Currently, Alma is in network with one regional insurance plan: Empire BlueCross BlueShield of New York. This means that, if you are a client and you want to use your health plan with an Alma provider, two things have to be true:

  • You need to be located in New York state when you are receiving care (either in-person or virtual), and

  • You need to have either an Empire BlueCross BlueShield or a participating BlueCard PPO insurance card.

    (BlueCard PPO is a partnership among the 35 independent Blue Cross Blue Shield plans. It allows clients located in New York state to see Empire BlueCross BlueShield providers using out-of-state Blues plans. You can find out more about BlueCard PPO eligibility here.)

Because there are so many Blue Cross Blue Shield plans, it can be challenging to identify an Empire BlueCross BlueShield insurance card. Here is an example of an in-network card to guide you and your clients:

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Note that actual Empire BlueCross BlueShield cards may have slight variations in spacing and layout. 

Can I still see an Alma provider if my Blue Cross Blue Shield plan is out of network?

If you are notlocated in New York state and you have a Blue Cross Blue Shield health plan,your insurance is currently out of network with Alma’s Insurance Program. (This includes common Blue Cross Blue Shield plans such as Anthem, Wellmark, and Horizon.)

That said, you can absolutely still seek care with an Alma provider:

  1. Many Alma providers accept Blue Cross Blue Shield outside of Alma’s insurance program. You can search our directory with the name of your health plan to find providers who may be in-network with your insurance.

  2. If you choose to work with an out-of-network provider, you could still be eligible for reimbursement directly from your health plan for Alma invoices. Call the phone number on the back of your insurance card to find out 
    • if you have out-of-network benefits, and 
    • what you need to file for reimbursement (for example, invoices or superbills, which are monthly statements of health care payments).

Alma is also constantly in conversation with network partners around the country. As we add more contracts with Blues plans in other regions, we will notify your provider, and you may become eligible for in-network rates in the future.

How do I add my insurance details to the Alma portal for verification?

Once you begin working with an Alma provider, if you are located in New York state and you have Empire BlueCross BlueShield or a participating BlueCard PPO health plan, your provider will add your insurance details to the Alma portal for eligibility verification.

Your provider can add your health plan information either by entering it themselves, on your behalf, or by sending you an email link for you to directly update our systems. This link will stay valid for 7 days. 

We strongly recommend that you have a copy of your insurance card in front of you when you use this link, and that you take a picture of the front and back of the card to upload into the Alma portal, so that our team can more easily verify the details of your health plan. 

If your provider sends you an insurance link, in the section labeled “Insurance Company,” you can either search Empire BlueCross BlueShield or you can enter the out-of-state Blue Cross Blue Shield plan you want to use for BlueCard PPO.

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For more information on identifying a BlueCard PPO plan and adding details to the Alma portal, you can review: Understanding BlueCard PPO. Please note that this option is only available to clients located in New York state, not to Blue Cross Blue Shield clients nationwide. If you are located outside of New York, you can speak to your provider about options for out-of-network care.

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