Have you ever been in a situation where you needed answers to a question about your health plan, or about how and where to get the health care you need, but you weren’t sure where to go or whom to call? Your answer is probably a resounding “Yes!” But we don’t want that to be the case for our members.
Questions about your health coverage are inevitable. We’ll be the first to acknowledge how confusing health care can be. And that’s why we have two dedicated groups — Member Service and myCare Navigator — to help with any issues or questions you have.
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Our myCare Navigator and Member Service representatives undergo weeks of extensive training, both in the classroom and on the phone, to learn how to provide the service and help you need and deserve when you call (or e-mail us, or contact us on Facebook or Twitter).
From helping you understand your health plan coverage to finding a new doctor, we have the people in place to address your concerns. To get the help you need as quickly as possible, here’s a guide on which needs are best answered by the myCare Navigator team and which require a call to the folks at Member Service.
When and Why to Call Our myCare Navigator Service
Here are the kinds of things that our myCare Navigator representatives can help you to do:
- Understand your provider network: If your plan network is changing in 2015, your provider options may also be changing. Instead of trying to figure it all out on your own, give myCare Navigator a call to find out which doctors and facilities are in network for you. You can also learn more about Highmark networks for 2015 online.
- Find a new PCP, specialist, or other provider: Here are a couple of examples of how myCare Navigator can help:
- You need to find a new primary care provider for you and/or your family member.
- You need more specialized physician care for a specific disease or condition, such as treatment for cancer.
- Get an appointment with a new doctor/provider: When you need an appointment with a new provider, myCare Navigator can help you find a doctor at a nearby location who can see you when it’s convenient for you. myCare Navigator can even initiate a 3-way call with you and the provider’s office. Or, if you prefer, you can give the myCare Navigator representative a preferred time and date for an appointment and he or she will make the necessary calls and get back to you.
- Transfer medical records: Switching providers and transferring medical records go hand-in-hand. With you on the line, myCare Navigator can contact your new provider and begin the process of transferring your records.
Watch a video on how myCare Navigator was able to help Rachel get an appointment with a new provider and transfer her medical records. You can also check out an overview of myCare Navigator to better understand the service and how it can benefit you.
To reach a myCare Navigator representative, dial 1-888-258-3428 and follow the prompt for option “2” to reach myCare Navigator.
Representatives are available weekdays 8 a.m. to 8 p.m. EST and weekends 9 a.m. to 5 p.m. EST.
When and Why to Call Our Member Service Line
Highmark health plans have been rated #1 in customer service and satisfaction, and our Member Service representatives are ready to help you in many ways:
- Check your plan coverage: Before having a procedure, seeing a specialist, or going to the pharmacy for a prescription, you’ll want to know who’s in network and what’s covered by your health plan. A Member Service representative can go over your health plan coverage with you.
- Questions about your Member ID: If you’re a new member and are wondering when you’ll get your new card, want an extra card, or don’t understand what the information on your card means, you can talk it over with Member Service. If you lost your card and/or are waiting for a new one to arrive, you also can use your Virtual Member ID card.
- Issues with claims: We get it; filing a claim is no fun and occasionally you’ll run into issues. But that’s why we have a Member Service team. Reach out to them and they’ll help you find the correct claim form, tell you what information to include and provide the appropriate mailing address.
- Billing issues: If you ever run into problems with paying your monthly premiums, you’ll want to call Member Service. They can take a variety of payment types over the phone, depending on the type of plan you have. There also is an online bill payment option that can be used after your first invoice.
- Help with online tools: If you have trouble registering or finding information on your Member website (the URL is on the back of your Member ID card), or understanding other online Member tools like the Provider Directory or Care Cost Estimator, Member Service can help you out.
- Help with your Spending Account: If you have a Health Savings Account (HSA), Flexible Spending Account (FSA), or Health Reimbursement Account (HRA), our Member Service team can help with everything from how to manage your spending account online to what counts as a qualified medical expense for your account.
You can reach Member Service by calling the number on the back of your ID card. Highmark health plans have different weekday service hours, but generally our Member Service lines are open from 8 a.m. to 5 p.m. EST Monday through Friday.
Also, in January 2015, Member Service representatives will be available on Saturdays for most members from 9 a.m. to 2 p.m. EST (hours will vary by health plan).
Resources to Prepare You for a Call with myCare Navigator or Member Service
Whether you’re calling myCare Navigator or Member Service, try to have as much information about your question or problem handy as you can so that our representatives can get up to speed with your specific situation quickly and get you the help you need in a timely manner.
For more information on both myCare Navigator and Member Service, check out: