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Blue Cross and Blue Shield of New Mexico Benefits Value Advisors (BVA) are ready to help you with your health care coverage questions. We’ve talked with a few of our BVAs to get some insight into the different situations that they’ve helped members navigate.
Check out their stories!
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 did not 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 pre-determination. I also explained their benefits to them and what things may need precertification. 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 asked to set them up with a Registered Nurse Case Manager to assist them as well. By the time this 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, and they should not have to worry about their health care coverage.
They thanked me over and over again and said they felt so much better as to what to expect with their benefits. I really felt I made a big difference.
Her group benefit center told her that her inactive status was due to a group error in terminating her policy and that a request to reinstate had been submitted, but to allow 3-4 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 this 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 supervisor at a BCBS FSU so they could assist with getting 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 who was 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, because as a Benefits Value Advisor I get to help members with their health care coverage questions every day. One day I might even help you!
AJ has been a Benefits Value Advisor for about a year. She lives in Illinois and volunteers for the Relentless Animal Rescue in her spare time.
In this instance, the member's previous insurance plan had expired and his new health care coverage was with Blue Cross and Blue Shield of Illinois (BCBSIL). 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 get connected with a doctor as soon as possible.
First, I researched in-network physicians that 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 appointments with. I contacted the doctors’ offices 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 have someone take responsibility and accountability in resolving his issue.
Once I had scheduled his appointments, I also referred him to the Blue Care Connection program which is an available through his health care coverage plan. Through this program, he was able to get set up with his own personal, registered nurse case manager. This member would now be able to speak one on one with a personal health clinician that would also be able to further assist him with accessing and understanding his specialty care.
As a BVA I am equipped to help members in all kinds of unique situations. If you have a question, give us a call.
A new member had just become effective with us from another insurance company and was calling for his daughter. She had to get medical supplies for her condition. The supplier that they had been using was not contracted through Blue Cross Blue Shield. I helped him locate a new provider that is 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 his daughter would have the supplies 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 so quickly in finding the right resources so that his daughter would not 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.
If you have health care coverage questions, BVAs are a great resource. To find out if your health care plan includes BVA, login to Blue Access for Members.
*Check with your doctor to confirm what tests are needed for pre-determination.
Benefits Value Advisors offer cost estimates for various providers, facilities and procedures. Lower pricing and cost savings are dependent on the provider or facility of your choosing.
Member communications and information from Benefits Value Advisors are not meant to replace the advice of health care professionals. Members are encouraged to seek the advice of their doctors to discuss their health care needs. Decisions regarding course and place of treatment remain with the member and his or her health care providers. Cost estimates are just an estimate. In addition to your usual deductibles, copayments and/or coinsurance, the actual cost of the services may vary based on a number of factors including the date of service, the actual procedure performed and what services were billed by the provider and your particular benefit plan. Coverage is subject to the limitations, exclusions and terms of your plan.
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