Because Blue Cross Blue Shield is neither a healthcare provider nor a managed care (health insurance) seller. BCBS is kind of like a franchising business, wher

Because Blue Cross Blue Shield is neither a healthcare provider nor a managed care (health insurance) seller. BCBS is kind of like a franchising business, where the franchisors get access to other members’ negotiated pricing and administrative services to create a larger (nationwide) network. For example, your employer could purchase managed care from Horizon BCBSNJ, and if you get into trouble on vacation on the west coast, then they coordinate with Elevance or BlueShield California or Regence in Washington/Oregon to figure out how much they are paying providers. And this way Horizon BCBSNJ does not have to do all the legwork of negotiating with every healthcare provider in the country. I’m sure it is quite a bit more complicated in practice though. > if you're with Kaiser, you go to Kaiser facilities for everything, as long as you're in the service area. Kaiser also sells PPO plans where you do not have to see a Kaiser employee for covered healthcare.