You Have Questions, and the Customer Service Team Has Answers

Insurance is confusing. Getting helpful answers to your questions is important. Our local Customer Service team members know that, and they’re eager to put your concerns to rest. The Blue Cross VT team won't simply read a script or turn your question over to a bot – they'll work with you until they resolve the issue.

You might wonder when you should get in touch. What kinds of questions are worth bringing to Customer Service? The answer: You can ask almost anything. “Every question has merit,” says Senior Customer Service Representative Susanna Culver.

“If there’s something you don’t understand about your coverage, please ask,” Susanna adds. “Knowledge is power, and the better you understand the way your plan functions, the better you’re able to use it.”

7 Common Questions Asked of Our Customer Service Team (and Their Answers)

To show the breadth of what Customer Service does and help you get the most out of your calls, here are seven types of questions that our reps hear often:
 

1. “What are my benefits for a specific service?” or “How much am I going to pay for a service?”
   When you’re calling to ask Customer Service about your expected costs for a procedure, it’s important to have a few details handy:
   • Who is your doctor?
   • Where and when are you getting the procedure done?

   • Did your doctor give you a service or procedure code (i.e., CPT code) to identify exactly what the procedure is?

     With that info, the Customer Service rep can then check what you’ve spent year-to-date, confirm your doctor’s in-network status, and verify your eligibility and expected cost share for the exact procedure you’re planning.

     Bonus Tip: You may not even have to call in to get a price estimate. We have a cost comparison tool in our Member Resource Center, and hospitals offer similar online estimators.

2.  “Why am I getting a bill for this service?”
   Receiving a bill when you’re not expecting one is a natural reason to call us. The Customer Service team can review a surprise bill with you and verify whether you’ve been charged in error. A few specific cases tend to lead to extra questions:
   • If you have a health savings account (HSA) or health reimbursement account (HRA): Some years, the money in your HRA or HSA may cover all your health expenses; in others it might not. Customer Service can connect with the fund manager and see what your responsibility is. 
   • If you’ve been charged for a lab: It’s worth checking with your provider to make sure a preventive lab will come with no out-of-pocket cost to you – not all are 100% covered.

3.  “Can you help me retrieve my password for the  member portal?” or “I’m signing up for the member portal, can you help set up my password?”
   Whether you’re setting up a Member Resource Center (MRC) account for the first time or you’ve forgotten your password, the Customer Service team can help you. And if you want to learn a little more about how the site works once you’ve gained access, our agents can give you a nice summary of everything you can do.

   Once you know your way around the MRC, you may be able to answer your next question without even picking up the phone. "At your fingertips you can access things like forms, benefits, network providers, cost comparisons, claims, proof of coverage and so much more," says Senior Customer Service Representative Terry Lyn Brickell.

4. “How does this specific element of my plan work?”
   When you're dealing with insurance, it's common to want definitions for the many technical terms involved. The Customer Service team is happy to explain. When you need to understand the difference between your deductible and your out-of-pocket maximum, or when you need to know how the service, claim, and liability processes work, you can call for clarity and peace of mind.
5. “Do I need a referral from insurance to see a specialist?”
   Some specialists require referrals from insurers, while others don’t. And in some cases, a referral will have to come from your primary care doctor rather than the insurance company. Calling Customer Service and laying out what type of specialist you’re considering seeing will help you determine which category your situation falls under.
6. “What does ‘eligible based on medical necessity’ mean?”
   If you need a term defined, reps will explain it in plain language. In this commonly seen case, “medical necessity” means doctors in the relevant field widely agree that a specific type of care is a scientifically sound way to treat your condition.
7. “Will my out-of-state medical provider know Blue Cross VT’s policies?”
   In some cases, out-of-state providers don’t have the same insurance contracts as those in Vermont, and they may not be required to obtain prior authorization on your behalf before providing a service. If you’re getting care elsewhere, it pays to double-check that you’re covered. Luckily, the Customer Service team is here to help with that.
    

Customer Service the Blue Cross VT Way

The Blue Cross VT approach to Customer Service is based on the idea that you deserve answers delivered by true experts. Rather than outsourced contractors who don't know the business, or AI bots that can't give your question the human touch it needs, our representatives are Vermonters like you who get where you're coming from.

“It’s a privilege to be allowed the time to provide personal and concierge service,” says Customer Service Representative Emalee Papin. “We understand that healthcare can be confusing, expensive and quite stressful. It’s our job and pleasure to help navigate the process.”