No doubt about it, the health care system can be confusing. Who can you turn to when you have questions about your health care coverage? Blue Cross and Blue Shield of New Mexico (BCBSNM) offers members a great go-to resource.

Get clear answers to your questions with just a phone call away or live chat from our mobile app. Our Benefits Value Advisors (BVA) are ready 24/7* to help you make the most of your benefits — from researching providers to providing cost estimates and so much more. We’ve talked with a few of our BVAs to get some insight into some of the different situations they’ve helped members navigate.

Check out their stories!

Being a BVA, I always strive to help each caller in any way I can. Sometimes the calls hit home and we’re able to really relate to a member's situation.

A husband and wife called in together on speaker phone. The husband did most of the talking as the wife was very upset. They had just found out that she had breast cancer. They were confused and didn't know what to do in regards to their health care coverage.

I empathized with them as I knew what they were going through; I am a breast cancer survivor. I started by explaining to them what tests were needed for a recommended clinical review (predetermination)** of her treatment plan. I also explained their benefits to them and what things may need prior authorization. I researched cost estimations and provided them with different costs for the different tests. I also made sure that all the providers they were using were in their network so they could get the highest level of benefits.

I offered to set them up with a registered nurse case manager to assist them, as well. By the time the call was finished, they felt more prepared and more comfortable with what to expect going forward with their health care coverage. I also provided them with my name and direct extension for any future questions.

I felt that I made a big difference for them, and told them that going through this is overwhelming enough. They shouldn't have to worry about their health care coverage. 

They thanked me over and over again, and said they felt so much better about what to expect with their benefits. I really felt I made a big difference.

--Janet

A member was frustrated after she was told her coverage wasn’t active when she tried to fill a prescription. She called her group benefit center, but was unsuccessful in getting to the bottom of the issue. That’s when she called the BVA phone number and was connected with me.

Her group benefit center told her that her inactive status was due to a group error in terminating her policy. A request to reinstate had been submitted, but it would be three to four days for processing. She explained her situation to me, and that she needed the medication sooner. I told her I would do everything I could to help get the issue resolved.

We called the group benefit center together and walked a supervisor through submitting an urgent request to BCBS membership for reinstatement. I then reached out to the prescription vendor to see what was needed to get the policy reinstated for coverage. Once they explained the process I called back to the group benefit center. I spoke to the same supervisor and had him submit the urgent request per the prescription vendor’s process. After ending that call, I reached out to a BCBS supervisor so they could help get the request processed ASAP. This process was done very quickly and the coverage was reinstated effective immediately. We then reached back out to the prescription vendor, they were able to do the same and reinstate the member’s policy.

From start to finish, this process took about two hours but by the time we were done, the member was extremely grateful. I have more stories like this one. As Benefits Value Advisor, I get to help members with their health care coverage questions every day. One day I might even help you!

--AJ

During BVA training we learn about the different opportunities we have to help our members. We are ready and waiting to help members when they are in confusing or frustrating situations.

In one instance, a member's previous insurance plan had expired and his new health care coverage was with BCBSNM. The member’s health required that he have lab work performed weekly. In addition to being on a new health care coverage plan, he had recently moved to a new state and wasn’t familiar with where he could go for care. He needed help connecting with a new doctor who could refer him to the right place to get his lab work done. By the time I got in touch with the member, he was feeling frustrated and needed to be connected with a doctor as soon as possible.

First, I researched in-network physicians who were accepting new appointments. The member also requested doctors who were associated with a specific hospital system. I pulled together a list of options, we reviewed them together, and he told me who he’d like to schedule an appointment. I contacted the doctor's office and got the appointment scheduled. Upon confirming his scheduled appointment, I was able to further assist him by locating an in-network lab that could take him in immediately for his specific lab work.

He was very pleased and relieved to have services available to him, and someone to take responsibility and accountability for resolving his issue.

As a BVA I am equipped to help members in all kinds of unique situations. If you have a question, give us a call.

--David

As a BVA with Blue Cross and Blue Shield, I strive to help members get the care and services they need. I work with members every day to help them find the right providers and to verify the associated costs.

A new member had just started with us from another insurance company and was calling for his daughter.  She had to get medical supplies for her condition. The supplier they had been using was not contracted through Blue Cross and Blue Shield.  I helped him locate a new provider that was PPO contracted and gave them a call to make sure they had the needed supplies.  I did a conference call with the provider and member to verify they had the information they needed to get the order started.

I made sure the supplies would be shipped right away.  I also confirmed that the member understood his new benefit plan including the deductible and out-of-pocket expenses. 

Our member was relieved that we were able to help him quickly find the right resources so his daughter wouldn't have any interruption in her treatment.  I felt good about helping this member because I have a daughter of my own and understand how important it is to take care of my family. 

--Suzie

If you have health care coverage questions, BVAs are a great resource. To find out if your health care plan includes BVAs, login to Blue Access for Members^SM.

* Excludes major U.S. holidays
**Check with your doctor to confirm what tests are needed for pre-determination.

Benefits Value Advisors offer cost estimates for procedures and services from various providers and facilities. Lower pricing and cost savings are dependent on the provider or facility you choose. Benefits Value Advisors do not give medical advice. Talk to your doctor or health care professional about any health questions or concerns.

Originally published 6/11/2018; Revised 2021, 2022, 2023