Kinda like the NBA… But they are all beholden to the same collective rules and practices. It’s not like the locally and independently owned nba teams can change the ball or court to benefit their team over the others. Small differences. Same game. Same commissioner tasked with insuring no one independently owned and operated organization does not stray too far from the path.

So if I start a company called Blue Cross Blue Shield in an area they don’t service, that’s A-OK right? I mean, if all these groups are just independent, with no central governing body, then there’s no one I’d need to get permission from. I can use the Blue Cross logo, I can create my own Blue Cross network, and I can make a website called therealbluecross.com and no one would be able to sue me.

Unless… There IS an actual body at the top. Someone who owns the trademark and gives these “independent, locally operated” groups their standards and policies they’re expected to abide by. Someone who would come knocking if someone started using their name without permission.