Caring Beyond the Chat Window

Cindy works to anticipate some of the questions that members might ask her, reading through their memberships and coverage and answering inquiries preemptively where possible. She tries to point out self-service options, places they can go to find their own answers without having to wait for a response from a team member.

But she also tries to assure that folks know what programs they qualify for and what resources are available to help them maximize their membership with Blue Cross NC. Some members qualify for nurse support and in-home care, and don’t realize it. Others might have interest in seeing a therapist or exploring gender affirmation treatment, but don’t know where to start or which team contact. Cindy acts as their advocate and steers them in the right direction.

“Based on my own personal experience, in life and with medical issues, I try and see all these issues from the member’s point of view,” she said. “I try to do the best I can to provide members with the best service while I have them on the phone or… through the chat window.”

But most impressive, perhaps, is Cindy’s encyclopedic knowledge of Blue Cross NC’s policies. She knows them like the back of her hand.

“There are some new policy changes in 2022 for certain plans, like the Blue Home, Blue Local and Blue Value plans,” Cindy explained. “They’re designed for use in-state, so if a member goes out of state for services rendered, emergency room visits will apply in-network, but other services may not.”

Many Customer Service Advocates spend much of their time clarifying the boundaries of a plan’s network for Blue Cross NC customers, so Cindy always recommends that members check the Treatment Cost Estimator Tool for upcoming provider visits and medical procedures. The tool will provide an estimated range of out-of-pocket costs for each procedure or service. Also, they can search for in-network providers using the Provider Service tool – saving members money on out-of-pocket expenses and assuring that no one is caught off guard.

“Sometimes I suggest that members use telehealth services for certain situations. You don’t have to leave the house; you can schedule the appointment at your convenience.” Cindy explained that she sometimes confides in members about her own use of the program.

“I tried it myself when I didn’t feel like going out. It worked really well for me!” she chuckled.

With every story and every laugh, Cindy embodies what many members need in their moments of confusion or crisis – an advocate. Someone who will listen closely to their needs and help chart a path forward through an often-confusing health care system.

“This is the first time I’ve done this!” Cindy remarked during the interview for this article. “I don’t know how to be the interviewee. I’m always helping other people!”

That’s what advocates do.