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Journal articles on the topic 'Blue Cross and Blue Shield of Missouri'

Author: Grafiati

Published: 4 June 2021

Last updated: 5 February 2022

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1

Ellenzweig, Harry, M. V. Ravindra, H. W. (Bill) Hagen, and Robert J. Vitelli. "Blue Cross and Blue Shield Parking Facility." PCI Journal 35, no. 1 (January 1, 1990): 26–36. http://dx.doi.org/10.15554/pcij.01011990.26.36.

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2

Bell, J. "The Future of Blue Cross and Blue Shield." JAMA: The Journal of the American Medical Association 280, no. 13 (October 7, 1998): 1138. http://dx.doi.org/10.1001/jama.280.13.1138.

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3

Jain, Mohit, Haley McKissack, Jun Kit He, Aaradhana J. Jha, Matthew Anderson, Charles Pitts, Ashish Brahmbhatt, and Amit Momaya. "Do Type of Insurance, Geographical Variation and Type of Practice Impact Access to Foot and Ankle Care?" Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0023. http://dx.doi.org/10.1177/2473011419s00230.

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Category: Foot & Ankle Introduction/Purpose: Medical coverage gap in United States refers to people who are uninsured because the state they are living has still opted-out of Medicaid expansion under Patient Protection and Affordable Care Act (PPACA) and they are too poor to be benefited from subsidies designed for middle-class Americans. A large percentage of this population lives in south. Despite increasing participation of the states in expanded Medicaid, it is still unclear that if such an expansion has led to improve the access to care. However, approximately one in three American is covered under Blue Cross Blue Shield (BCBS) private insurance. The purpose of this study is to determine the access to foot and ankle care based on medical insurance, nature of illness and Medicaid expansion of the state. Methods: Five pairs of Medicaid expended (California, New York, Ohio, Minnesota and Washington) and non-expanded (Utah, Texas, Alabama, Missouri, and North Carolina) states with different geographic location were selected for the study. Twenty providers from each state were randomly selected via American Orthopedic Foot & Ankle Society (AOFAS) directory with private or academic affiliations. Each provider’s office was contacted by fictitious call for the earliest available appointment in foot and ankle clinic. A standardized script was used by the same researcher every time for a 30 year old male patient with acute Achilles tendon rupture or chronic bunion with either Medicaid or BCBS insurances. Available appointment for physician was considered as an access to foot and ankle care. We registered time until appointment (if given) and reason for denial (if denied) on phone. We also recorded requirements for insurance details, PCP (Primary Care Physician) referral or imaging records. Results: 200 providers’ offices were contacted on phone for foot and ankle clinic appointment. Successful appointment was given by 36%(72/200) offices irrespective of condition and insurance. 29% of calls with Medicaid could successfully schedule an appointment compared to 43% when calling with BCBS(P=0.03). Success rate for appointment was same for Achilles rupture and Bunion (36% each). The mean time until earliest appointment was 10.7(range 1-37) days with Medicaid and 10.5 (range 1-45) days with BCBS. For Medicaid patients, no significant difference was found in appointment rates between expanded states (30%) and non-expanded (28%) states (P=0.82). Overall appointment success rate was highest in Utah (65%) and lowest in New York (10%). Differences were observed across geographical locations, as well as between academic and private institutes. Conclusion: In our study, access to foot and ankle care clinic seems to be significantly better with BCBS private insurance compared to Medicaid. Sample size is surely a limitation, but we have included more states than similarly-designed studies for better geographic variability. There was no significant difference for appointment wait-time between Achilles tendon rupture and Bunion as well as Medicaid and BCBS insurance. Medicaid expansion facility in the state has not been associated with higher success rate but associated with lengthening of wait-time. Inability to provide insurance details or PCP-referral is definitely an important barrier for the access to podiatric care.

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4

Riedel, John E. "Employee Health Promotion: Blue Cross and Blue Shield Plan Activities." American Journal of Health Promotion 1, no. 4 (March 1987): 28–32. http://dx.doi.org/10.4278/0890-1171-1.4.28.

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5

BENNETT, C. "The blue cross blue shield assessment technology review: summary of findings." Best Practice & Research Clinical Haematology 18, no. 3 (September 2005): 423–31. http://dx.doi.org/10.1016/j.beha.2005.01.019.

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6

Geisler, Greg. "Blue cross and blue shield of south carolina: Program for clerical workers." Telematics and Informatics 2, no. 2 (January 1985): 169–73. http://dx.doi.org/10.1016/s0736-5853(85)80011-3.

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7

&NA;. "Criticism of the Evidence on Disc Replacement From Blue Cross Blue Shield." Back Letter 20, no. 7 (July 2005): 78–80. http://dx.doi.org/10.1097/00130561-200507000-00009.

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8

Wardwell, W. I. "The Blues: A History of the Blue Cross and Blue Shield System." JAMA: The Journal of the American Medical Association 279, no. 9 (March 4, 1998): 714–15. http://dx.doi.org/10.1001/jama.279.9.714.

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9

Rosner, David, Robert Cunningham III, and Robert M. Cunningham Jr. "The Blues: A History of the Blue Cross and Blue Shield System." Journal of American History 85, no. 2 (September 1998): 739. http://dx.doi.org/10.2307/2567880.

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10

Rohan, Timothy M. "Challenging the Curtain Wall: Paul Rudolph's Blue Cross and Blue Shield Building." Journal of the Society of Architectural Historians 66, no. 1 (March 1, 2007): 84–109. http://dx.doi.org/10.1525/jsah.2007.66.1.84.

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11

Waalen, J. "Blue Cross/Blue Shield Decides To Cover Costs for Some Clinical Trials." JNCI Journal of the National Cancer Institute 82, no. 23 (December 5, 1990): 1804–5. http://dx.doi.org/10.1093/jnci/82.23.1804.

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12

Riedel, John E., and Carol Henes. "Cardiovascular Risk Programs: Developments within the Blue Cross and Blue Shield Organization." Occupational Health Nursing 33, no. 5 (May 1985): 245–46. http://dx.doi.org/10.1177/216507998503300508.

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13

Northrup, Herbert R. "The AFL-CIO Blue Cross-Blue Shield Campaign: A Study of Organizational Failure." Industrial and Labor Relations Review 43, no. 5 (July 1990): 525. http://dx.doi.org/10.2307/2523326.

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14

Langley, Paul C. "Formulary Submission Guidelines for Blue Cross and Blue Shield of Colorado and Nevada." PharmacoEconomics 16, no. 3 (1999): 211–24. http://dx.doi.org/10.2165/00019053-199916030-00001.

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15

Helm-Murtagh, Susan C. "Use of Big Data by Blue Cross and Blue Shield of North Carolina." North Carolina Medical Journal 75, no. 3 (May 2014): 195–97. http://dx.doi.org/10.18043/ncm.75.3.195.

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16

Pugliese, Gina. "Blue Cross and Blue Shield Extends Occupational HIV Coverage to All Its Employees." Infection Control & Hospital Epidemiology 15, no. 5 (May 1994): 356. http://dx.doi.org/10.1017/s0195941700009760.

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17

Northrup, Herbert R. "The AFL-CIO Blue Cross—Blue Shield Campaign: A Study of Organizational Failure." ILR Review 43, no. 5 (October 1990): 525–41. http://dx.doi.org/10.1177/001979399004300502.

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18

&NA;. "Blue Cross-Blue Shield Finds Inadequate Evidence on Disc Replacement for All Ages." Back Letter 22, no. 6 (June 2007): 65. http://dx.doi.org/10.1097/01.back.0000280895.59188.6f.

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19

Callahan, Donna K., Joyce Scotten Finn, and Lyn R. Killman. "Health Care Financing Administration and Blue Cross and Blue Shield of Maryland Programs." Occupational Health Nursing 33, no. 5 (May 1985): 247–50. http://dx.doi.org/10.1177/216507998503300509.

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20

Tennenbaum, David. "Blue Cross and Blue Shield Association’s perspective on the common diagnostic testing guidelines." Journal of General Internal Medicine 4, no. 6 (November 1989): 553–54. http://dx.doi.org/10.1007/bf02599559.

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21

Klanica, Kaley. "Managed Care: Immunity for Peer Review under HCQIA." Journal of Law, Medicine & Ethics 31, no. 1 (2003): 160–61. http://dx.doi.org/10.1111/j.1748-720x.2003.tb00070.x.

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In Singh v. Blue Cross/Blue Shield of Massachusetts, Inc., the U.S. Court of Appeals for the First Circuit held that defendant Blue Cross/Blue Shield's peer review practices satisfied the immunity standard for professional review actions according to the Health Care Quality Improvement Act (HCQIA), and the First Circuit affirmed the U.S. District Court for the District of Massachusetts's grant of summary judgment in favor of the defendant.After Blue Cross/Blue Shield merged with Bay State Health Care, Blue Cross began to offer “Bay State Health Care” to former Bay State subscribers. Blue Cross denied the plaintiff, Dr. Kunwar Singh, participation in the Bay State Healthcare Network due to poor utilization review. Singh sought reconsideration, and Blue Cross agreed to audit his practices before making a final decision.

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22

Booth, Bridget, and Matt McCredie. "Taking steps toward “Getting to Yes” at Blue Cross and Blue Shield of Florida." Academy of Management Perspectives 18, no. 3 (August 2004): 109–12. http://dx.doi.org/10.5465/ame.2004.14776178.

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23

Liu, M., X. Yuan, J. Ouyang, J. Chaisson, T. Bergeron, D. Cantrell, V. Washington, Y. Zhang, and S. Nigam. "Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana." Journal of Medical Economics 23, no. 6 (February 13, 2020): 557–65. http://dx.doi.org/10.1080/13696998.2020.1722677.

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24

Padgug, Robert A. "Looking Backward: Empire Blue Cross and Blue Shield as an Object of Historical Analysis." Journal of Health Politics, Policy and Law 16, no. 4 (1991): 793–805. http://dx.doi.org/10.1215/03616878-16-4-793.

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25

Oswald, Sharon. "Indicators of Hospital Closure Under PPS and Blue Cross/Blue Shield Cost-Based Reimbursements." Journal of Hospital Marketing 6, no. 2 (October 26, 1992): 149–82. http://dx.doi.org/10.1300/j043v06n02_08.

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26

Ziegler, Kathleen M., Carole Redding Flamm, and Naomi Aronson. "The Blue Cross Blue Shield Association Technology Evaluation Center: How we evaluate radiology technologies." Journal of the American College of Radiology 2, no. 1 (January 2005): 33–38. http://dx.doi.org/10.1016/j.jacr.2004.07.002.

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27

Watson, Hugh J., Celia Fuller, and Thilini Ariyachandra. "Data warehouse governance: best practices at Blue Cross and Blue Shield of North Carolina." Decision Support Systems 38, no. 3 (December 2004): 435–50. http://dx.doi.org/10.1016/j.dss.2003.06.001.

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28

Collins, Sonya, Hebert-Silvia, and Higgins. "Blue Cross & Blue Shield of Rhode Island pharmacist program engages patients improves star ratings." Pharmacy Today 21, no. 11 (November 2015): 54–55. http://dx.doi.org/10.1016/s1042-0991(15)32135-6.

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29

Marmor, Theodore R. "New York's Blue Cross and Blue Shield, 1934–1990: The Complicated Politics of Nonprofit Regulation." Journal of Health Politics, Policy and Law 16, no. 4 (1991): 761–92. http://dx.doi.org/10.1215/03616878-16-4-761.

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30

Dunlap, Rod, and Mary Lacity. "Resolving Tussles in Service Automation Deployments: Service Automation at Blue Cross Blue Shield North Carolina (BCBSNC)." Journal of Information Technology Teaching Cases 7, no. 1 (May 2017): 29–34. http://dx.doi.org/10.1057/s41266-016-0008-9.

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31

Fox, Daniel M., David Rosner, and Rosemary A. Stevens. "Between Public and Private: A Half Century of Blue Cross and Blue Shield in New York." Journal of Health Politics, Policy and Law 16, no. 4 (1991): 643–50. http://dx.doi.org/10.1215/03616878-16-4-643.

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32

Booth, Bridget, Reneé Finley, and Matt McCredie. "Blue Cross and Blue Shield of Florida implements a system for measuring and reporting alliance performance." Strategy & Leadership 33, no. 5 (October 2005): 39–45. http://dx.doi.org/10.1108/10878570510616870.

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33

Thomasson, Melissa A. "Early evidence of an adverse selection death spiral? The case of Blue Cross and Blue Shield." Explorations in Economic History 41, no. 4 (October 2004): 313–28. http://dx.doi.org/10.1016/j.eeh.2004.02.001.

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34

Karve, Amrita M., Milan Seth, Manoj Sharma, Thomas LaLonde, Simon Dixon, David Wohns, and Hitinder S. Gurm. "Contemporary Use of Ticagrelor in Interventional Practice (from Blue Cross Blue Shield of Michigan Cardiovascular Consortium)." American Journal of Cardiology 115, no. 11 (June 2015): 1502–6. http://dx.doi.org/10.1016/j.amjcard.2015.02.049.

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35

Harris, Robert T. "The Payer Perspective: Blue Cross and Blue Shield of North Carolina’s Approach to the Obesity Epidemic." North Carolina Medical Journal 67, no. 4 (July 2006): 313–16. http://dx.doi.org/10.18043/ncm.67.4.313.

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36

B.L.G. "Ohio Court Finds Blue Cross Liable for Misleading Copayment Charges." Journal of Law, Medicine & Ethics 23, no. 4 (1995): 409–10. http://dx.doi.org/10.1017/s1073110500006525.

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On August 29, 1995, the United States District Court for the Northern District of Ohio ruled that certain practices of Blue Cross and Blue Shield of Ohio (BCBSO) relating to the calculation of copayments on insurance claims violated provisions of ERISA, and thus BCBSO could be liable for unpaid benefits and breach of fiduciary duty (McConocha v. Blue Cross & Blue Shield of Ohio, 1995 WL 561444 (N.D. Ohio Aug. 29, 1995)). According to BCBSO's Explanation of Benefits and Schedule of Benefits, beneficiaries were responsible for a 20 percent copayment for hospital charges, and the remaining 80 percent of the Provider's Reasonable Charges would be paid by BCBSO. BCBSO negotiated with the hospitals to create discount agreements whereby the actual charge to BCBSO was less than 80 percent of the total amount of the hospital's charges. By this arrangement, BCBSO paid less than 80 percent of what patients were billed; concurrently, patients paid more than 20 percent of the amount ultimately paid to hospitals for their services.

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37

M.K. "Tenth Circuit Upholds BC/BS's Anti-Assignment Provisions." Journal of Law, Medicine & Ethics 24, no. 1 (March 1996): 72–73. http://dx.doi.org/10.1017/s1073110500004599.

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In St. Francis Regional Medical Center v. Blue Cross & Blue Shield of Kansas (49 F.3d 1460 (1995)), the United States Court of Appeals for the Tenth Circuit upheld Blue Cross/Blue Shield of Kansas's anti-assignment requirement, on the grounds that the Employee Retirement Income Security Act (ERISA) preempted a hospital's claim against Blue Cross. The court also held that public policy supported anti-assignment requirements in health plans not covered under ERISA.When drafting ERISA, Congress did not explicitly address assignability of health care benefits. According to the court of appeals, congressional silence constituted an intent to allow the parties to negotiate freely the assignment of health care benefits. Examining non-ERISA health plans, the court adopted a balancing test to determine the validity of anti-assignment clauses; it found that anti-assignment requirements promote freedom of contract and may include medical costs.

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38

Williams, H., S. Guh, A. Barrack, K. Boss, and S. Nigam. "Long-Term Benefits of Employee Wellness Programs: A Blue Cross Blue Shield of Louisiana (BCBSLA) Case Study." Value in Health 21 (May 2018): S140. http://dx.doi.org/10.1016/j.jval.2018.04.946.

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39

McDonagh, Jonathan, Simon Dixon, Thomas LaLonde, David Wohns, Akshay Khandelwal, and Hitinder Gurm. "DOES RADIAL PCI NEGATE THE OBESITY PARADOX? INSIGHTS FROM BLUE CROSS BLUE SHIELD OF MICHIGAN CARDIOVASCULAR CONSORTIUM." Journal of the American College of Cardiology 63, no. 12 (April 2014): A1621. http://dx.doi.org/10.1016/s0735-1097(14)61624-7.

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40

McDonagh, Jonathan R., Milan Seth, Thomas A. LaLonde, Akshay K. Khandewal, David H. Wohns, Simon R. Dixon, and Hitinder S. Gurm. "Radial PCI and the obesity paradox: Insights from blue cross blue shield of michigan cardiovascular consortium (BMC2)." Catheterization and Cardiovascular Interventions 87, no. 2 (May 22, 2015): 211–19. http://dx.doi.org/10.1002/ccd.26015.

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41

Corbett, Christopher. "Stewardship of public assets under nonprofit conversion models: New York's Empire Blue Cross Blue Shield case study." Nonprofit Management and Leadership 16, no. 2 (2005): 153–69. http://dx.doi.org/10.1002/nml.98.

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42

Bradley, Don, and David R. Rubinow. "UNC Health Systems and Blue Cross and Blue Shield of North Carolina Patient-Centered Medical Home Collaborative." North Carolina Medical Journal 72, no. 3 (May 2011): 223–24. http://dx.doi.org/10.18043/ncm.72.3.223.

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43

Shi, Q., L. Shi, P. Lee, P. Murphree, and X. Yuan. "Effects of the Quality Blue Primary Care Program on Health Outcomes in Patients Covered by the Blue Cross Blue Shield of Louisiana." Value in Health 19, no. 3 (May 2016): A26. http://dx.doi.org/10.1016/j.jval.2016.03.328.

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44

Blayney, Douglas W., Philip J. Stella, Thomas Ruane, Jane Martin, Beth LaVasseur, Thomas Leyden, and Mary Malloy. "Partnering With Payers for Success: Quality Oncology Practice Initiative, Blue Cross Blue Shield of Michigan, and the Michigan Oncology Quality Consortium." Journal of Oncology Practice 5, no. 6 (November 2009): 281–84. http://dx.doi.org/10.1200/jop.091043.

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More than 16% of the total sites participating nationally in the QOPI survey are in Michigan. A significant component of the growth in QOPI participation in Michigan can be attributed to the involvement and quality improvement efforts of Blue Cross Blue Shield of Michigan.

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45

Steingisser, Lee, Brian Acker, Stuart Berman, Mark J. Brenner, Bruce A. Bornstein, Paul Busse, Thomas J. FitzGerald, et al. "Bending the Cost Curve: A Unique Collaboration Between Radiation Oncologists and Blue Cross Blue Shield of Massachusetts to Optimize the Use of Advanced Technology." Journal of Oncology Practice 10, no. 5 (September 2014): e321-e327. http://dx.doi.org/10.1200/jop.2014.001473.

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Because of increased treatment planning time and quality assurance, IMRT is costly. Blue Cross Blue Shield of Massachusetts and the Massachusetts Radiation Oncology Physicians Advisory Council have developed a strategy to develop standards for the appropriate use of IMRT.

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46

Liu, M., S. Guh, J. Chaisson, K. Tisdale, and S. Nigam. "A Case Management Approach to Reducing ER Visits: A Blue Cross Blue Shield of Louisiana (BCBLSA) Case Study." Value in Health 21 (May 2018): S129—S130. http://dx.doi.org/10.1016/j.jval.2018.04.870.

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47

Edmiston, Robert B., Leta M. Beam, and Edward P. Shapiro. "Do Hospitals Adhere to the Blue Cross/ Blue Shield Association's Guidelines for Admission Chest X-rays and ECGs?" Quality Assurance and Utilization Review 6, no. 3 (September 1991): 76–81. http://dx.doi.org/10.1177/0885713x9100600303.

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48

MOSCUCCI, MAURO, DAVID SHARE, EVA KLINE-ROGERS, MICHAEL O'DONNELL, ANN MAXWELL-EWARD, WILLIAM L. MEENGS, VIVIAN L. CLARK, et al. "The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Collaborative Quality Improvement Initiative in Percutaneous Coronary Interventions." Journal of Interventional Cardiology 15, no. 5 (October 2002): 381–86. http://dx.doi.org/10.1111/j.1540-8183.2002.tb01071.x.

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49

KLINE-ROGERS, EVA, DAVID SHARE, DIANE BONDIE, BRUCE ROGERS, DEAN KARAVITE, SHERRI KANTEN, PATRICIA WREN, et al. "Development of a Multicenter Interventional Cardiology Database: The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Experience." Journal of Interventional Cardiology 15, no. 5 (October 2002): 387–92. http://dx.doi.org/10.1111/j.1540-8183.2002.tb01072.x.

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50

Palmer, Laura F., and Carey W. Hepler. "How Blue Cross and Blue Shield of Florida use Personal Health Reports to inform and educate its members." Journal of Communication in Healthcare 1, no. 1 (January 2008): 32–50. http://dx.doi.org/10.1179/cih.2008.1.1.32.

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