Doctor and patientLet me shoot a scenario your way: You’re a Highmark member who has just moved. You’re going through the hassle of unpacking all of those boxes you just recently stuffed full of your belongings. While worrying about organizing, cleaning and figuring out where everything is in this new town, you notice the signs of an oncoming illness. Great, now what are you going to do? You’re new to the area and don’t know a thing about the local doctors or how long you would have to wait to get an appointment. You need to find a provider quickly, but where do you even begin?

Enter Highmark’s My Care Navigator service. By simply dialing the Blues On Call number on the back of your member ID card (1-888-BLUE-428 or 1-888-258-3428) and following the prompt to press “2” to reach My Care Navigator, you’ll be directed to an experienced representative with access to the answers to all of your health care questions. All you need is your member ID, date of birth and address.

Family Members Can Take Advantage of the Service, Too

You’re not the only one who can use My Care Navigator — your immediate family members can, too: spouse, domestic partner, dependent children, parents and parents-in-law. Even if they do not have Highmark health insurance, they can call My Care Navigator for help. All they need to do is provide your name and member ID number if you’re the main “policyholder” on the Highmark plan.

Now, in your need-to-find-a-provider scenario, here’s how your phone call with My Care Navigator can help to ease your mind: The representative advises you that they will locate providers close to your new location and contact them to see if one can see you on short notice. After finding a doctor in your area, the representative offers to help you schedule an appointment with the provider.

The My Care Navigator representative may complete the appointment scheduling process by calling the provider’s office and conferencing you in to a 3-way conversation. Or, if preferred, My Care Navigator may even be able to schedule the appointment for you themselves. Either way, My Care Navigator ensures that the provider has the necessary insurance information and that you know what time to arrive for your appointment and what to bring with you.

With your appointment made, you can hang up the phone, smile and feel relieved knowing that you’ll soon receive the medical attention you need.

What Kind of Help Can My Care Navigator Provide?

Raise your hand if you feel like you know everything you need to know about your health plan or how to use the health care system.

I’m going to go out on a limb and guess that not many hands went up in the air. But that’s OK.

One of the most rewarding aspects of calling My Care Navigator is the chance to speak directly with a person who’s dedicated to helping you resolve your issues. The representatives are specially trained to handle a wide variety of scenarios, ensuring that you will get the help you need without having to jump through hoops or make multiple calls. The person you speak with has a commitment to help you “navigate” the confusing world of health care.

So, what are some of the other things My Care Navigator representatives can do for you — or for your family member who also can benefit from this service through your Highmark membership?

1.  Find You a Doctor. Whether you’re in need of a primary care physician (PCP) or more specialized care, My Care Navigator can help you find an in-network doctor who suits your needs. And if you’re having difficulty locating providers with expertise in certain conditions, My Care Navigator can connect you with a health coach to assist in finding and/or determining the right type of provider to treat your specific condition.

For the complex circumstances or questions that may take more time to delve into or answer on a shorter call, a representative will ask for your contact information, go do all the leg work for you, and give you a call back when the question has been answered or the problem solved. It’s that simple.

If you are calling My Care Navigator for help with finding a doctor, have this information ready when you call:

    • Your three-letter alpha prefix (the three letters before your member ID number on your member ID card)
    • The type of provider you’re looking for
    • Your preference for a male or female, if you have one
    • The maximum number of miles you’re willing to travel to see a provider, either from your home address zip code that we have on file, or a new one that you specify

2.  Get You an Appointment. Everybody gets sick. It’s an unavoidable part of life. And when you’re sick, you want medical attention when it’s convenient for you. Getting a doctor’s appointment on short notice usually is a daunting task.

But My Care Navigator can help get you (or your immediate family member) an appointment with a local doctor — or even one in another state, if you’re vacationing and have a medical problem, for instance. Even with hard-to-reach specialists, a representative can help you get an appointment promptly. Just have your member ID number handy when you make the call to My Care Navigator.

Medical records3.  Transfer Your Medical Records. Are you switching providers? If so, your medical records will need to be transferred to your new provider. But how do you do that? Don’t sweat it. With you on the line, a My Care Navigator representative will contact your new provider and state that you would like to transfer your records. From there, your provider and the My Care Navigator representative will take care of what needs to be done on their end, and point you in the direction you need to go to complete the process.

There should be no cost to you to have your records transferred from one provider to another. However, if you would like a copy for yourself — which under law you have a right to receive — the provider can then charge a fee. In some instances, the provider currently holding your records may require a signature from you before proceeding with the request. My Care Navigator can help walk you through all of this.

4.  Find Helpful Services for You and Your Family. Perhaps you’re interested in enrolling in an exercise program and you’re hoping your health plan offers some sort of discount. Give My Care Navigator a call and they can walk you through your member discount offers — and help you keep more money in your pocket. Even if a service you want isn’t covered by your health plan, representatives can still help you out by scanning your area to check if that service is offered in your community.

5.  Help You Make Informed Care Decisions. “Am I using providers that offer high-quality care at a reasonable cost?” That’s a fair question and something we all should wonder, especially since most of us have to pay a certain amount upfront in copays, coinsurance and/or deductibles when we see a doctor or go to a lab or hospital for a test or procedure. My Care Navigator can direct you to the information and resources you need — such as the Find a Doctor and Care Cost Estimator tools on your Highmark member website, which can help you make informed health care decisions.

When Should You Call My Care Navigator or Highmark Member Service?

The My Care Navigator service is available to most Highmark members in Pennsylvania, West Virginia and Delaware with individual and group plan coverage (and their immediate family members, as indicated above). Although My Care Navigator is not available with Medicare plans, if you’re a Highmark Medicare member, you can contact your Highmark Member Service team with any questions and needs.

You can call My Care Navigator for help, or to find out if the service is part of your plan. The service is available Monday to Friday, 8 a.m. to 8 p.m.

You may be wondering when to call My Care Navigator — and when to call Highmark Member Service.

First, it’s important to know that My Care Navigator is not meant to replace Member Service. For complex situations regarding finding providers, call My Care Navigator. Maybe the PCP you’ve been seeing your whole life is retiring, or no longer in your plan’s network, and you’re panicking about having to find a new doctor. Or perhaps you‘ve recently switched to Highmark health insurance and you need to transfer your medical records to a new provider but you’re not sure which providers are in your network — that’s another good reason to call My Care Navigator.

For more general questions about your plan, including benefit details, call the representatives at Member Service. If you have a question about a claim or are wondering when your new member ID card will arrive, that’s a job for Member Service, too.

Find some relief in knowing that even in the event of a change in your location, your PCP’s retirement, needing to find an in-network specialist and make an appointment, and more, My Care Navigator has your back.