In fact, our Member service representatives are given extensive classroom and telephone training in a lab setting for about six months before they begin assisting members—they even receive a Corporate Learning Services Certification to ensure that they’re fully prepared to solve your questions and issues.
In order to make the most of your call to us, make sure you’re ready to talk! Here are just a few of the ways you can make your call more productive, easier, and perhaps faster, too:
Although we always welcome any call from our members, it can often be more convenient to take a look at your Member website to see if your question can be answered or resolved there.
The Member site is available to you 24/7. You can find plenty of information there, from searching for a provider for you and your family to creating a Personal Health Record (PHR). If you haven’t yet visited your Member site, consider doing so – it’s a great resource for your health care needs.
For example, status updates on claims may be found on the website. Simply go to the URL on the back of your Member ID card, log in to the site (or register if you haven’t already), and then click on the “Claims” tab.
From that page, you can navigate to various claims as well as spending account (if you have one) information. Claims from the past 60 days will automatically display, but you can view up to two years of claims on the site. You also can view, download, and print plan activity statements, Explanation of Benefits (EOB) documents, or other statements related to your plan.
Under “Spending,” you can see health account information and cost-savings tools information. The “Find a Doctor” tab lets you find local health care professionals. The “Wellness” tab provides educational content on many health issues, a symptoms checker and a variety of health centers for specific groups of people.
Need to talk to Member Service about a claim or prescription issue? Have the name and phone number for the physician (or for another kind of provider, such as lab, pharmacist, or chiropractor, depending on your question) with you when you call us. We often contact providers on our members’ behalf to get any additional information we need to answer their questions and process claims, for example.
Question about medication coverage or drug costs under your plan? Make sure you have the medication name and dosage information. If you’re calling to find out if a particular procedure or treatment is covered, ask your doctor for the medical diagnosis or procedure/CPT codes. Those codes can help us to more easily determine if your particular health plan covers it and what your out-of-pocket costs, if there are any, might be.
You also might be able to find detailed coverage and eligibility information in your benefits booklet. These booklets are online for most plan members, but you can check for yours under the “Coverage” tab. Don’t worry if you can’t find it — or can’t find the procedure or treatment information you need in the booklet. Member Service can locate it for you.
As part of your call to Member Service, we’ll ask for your Highmark Member ID number. You can find it on your plastic Member ID card or, if you don’t have the card handy, on your Member website. (There’s an “ID” link on the homepage after you log in.)
If you’re calling with coverage questions about one of your dependents (covered family members), their number will be the same as yours. However, keep in mind that there may be limits on what a Member Service representative can tell you about other family members’ health claims.
They may be able to discuss general claims and cost information with you, but not provider or health diagnosis information, for instance. This policy helps to protect personal health information (PHI).For example, if one of your dependents is over 18, our Member Service representative cannot discuss their claims with you without their permission. If the dependent is over the age of 14 and the diagnosis is related to behavioral health, they cannot discuss it with anyone but the dependent.
However, if you are a parent, spouse, or child who helps to manage a family member’s health care and coverage, you can request permission to access their health plan information going forward. Your or your family member can call Member Service to request an Authorization to Disclose Health Information (ADHI) form.
Remember, you can find your health plan statements on the Highmark Member website, along with your health account information if you have a health spending account (HSA), for instance. You may be able to compare these yourself and figure out what was paid and what is still owed. Of course, you can contact Member Service if you still need help. There may be other statements from Highmark or from your provider that could be valuable to have with you for the call.
It’s also worth keeping in mind that a physician, hospital, or other provider’s bill is different from an EOB or any other statements you might receive from Highmark. Highmark does not send bills for medical services. Those always come from your provider.
If you’re missing a medical bill, or have a question about a medical bill itself, you may need to get in touch with your provider. If you are calling us about a bill, have the billing account number and phone number for the billing office ready. A billing phone number is usually different from the doctor’s office number.
Before you call, write out the questions you’d like to ask so that you’re clear on exactly what you need to ask (and so you don’t forget something when you’re on the call). Feel free to take notes on the answers you receive. While it can sometimes be challenging to jot things down during your call, if you take notes, this could help you down the road.
We recommend you keep those notes in one place, such as an electronic document or notebook. Label each note with the date of the call, the number you called and the name of the person you spoke with.
Our goal is to resolve a member’s issue in one call, which we call First Call Resolution. We’ll talk more about this program in a future post.
We want to help you have the best call possible with us. The more information you have available, the better. Not only will you be better informed about your health care coverage, you’ll also be able to provide your Member Service representative with the information they need to help you as best they can.
If you have a member service question that involves personal health or insurance information, do not use the "comments" feature; please call the number on the back of your Member ID card.