This article is intended for members enrolled in an employer health insurance plan.
When his wife was diagnosed with Alzheimer’s, the elderly man cared for her at home as long as he could. When he was no longer able to manage her needs, he placed his spouse of more than 40 years in a facility where she could have round-the-clock care.
His worries about her health and safety were somewhat relieved, only to be replaced by different concerns: The health insurance claims were mounting. And when his wife died a year later, he was left with a pile of bills.
That’s when Leah Blan stepped in. “Because a couple of providers didn’t know how to reconcile their Explanation of Benefits, I would get frequent calls from the husband,” Leah said. He was confused by the account statements.
“It was to the point I knew his phone number and ID numbers by heart. He would tell me when and where he was going on vacation,” she said. “I knew about his children and grandchildren and how he had stacks of paper on the desk and the table.”
Leah worked with the man and with providers to reconcile the bills. Then one day his name came across her desk. He had died unexpectedly of a massive heart attack while on a trip with his son.
“It was hard for me,” Leah said. “I felt like I knew him. It was almost like a family member or a friend had passed.” But his case was easier to resolve because of her connection with him. “I was able to help his daughter and could even tell her where to look for paperwork in his house.”
Leah is a customer advocate specialist for Blue Cross and Blue Shield. She is assigned to the Seasons of Life team. The team helps families of deceased members — closing claims, determining liabilities and helping them navigate their health insurance.
We Can Help
The Seasons of Life team provides a service that members might not expect from an insurance company.
“We reach out to let our members know we’re here for them,” said Lisa Wassom, senior manager of subscriber services.
When a member dies, the team learns of the death through cancellation reports, medical management recommendations, customer service channels or other referrals. They may get anywhere from 20 to 60 cases a day.
For each deceased member, a customer advocate is assigned to be the survivors’ point of contact. After the family has been allowed some private time, the advocate will send a handwritten sympathy card, offering assistance.
The advocates make sure all claims are filed and processed properly and resolve billing issues with providers, and even with other insurance companies when necessary. The advocates attend to details like getting survivors transferred to a new policy and generally try to help ease the burden of loss.
“We take the family out of the middle. We’re their personal family advocate,” said Debra Griffin, one of the Seasons of Life specialists. “We’re able to give support to families at a very tough point in their lives.”
Each advocate tackles dozens of cases monthly, said Melissa Scyffore, the customer advocate examiner for the team. Sometimes data may have been entered incorrectly or documentation like medical records may need to be obtained to resolve a case.
To make sure all claims are addressed, the advocate examines all the charges in the year before a member’s date of death.
“We go over the claims and make sure they are correct — that if there are denials, they are correct. We try to take care of things so they don’t run into anything down the road,” Debra said.
In one of Debra’s cases, a woman’s husband died, leaving more than 200 claims to be reviewed. “She was being billed for over $1 million. We were able to get that resolved for her, making many, many calls back and forth to the providers. We worked on her behalf for several months.”
The woman had been overwhelmed, Debra said. “Every time she called, she would cry.”
Debra said the advocates help with matters that the families might ordinarily have been able to handle themselves, were they not so burdened by loss.
Debra, who has lost both of her parents, understands that sense of loss and knows what it would have meant to have someone reach out during that time.
“I don’t know of another insurance company that does that,” she said. “It’s a unique situation. We can touch them in a way that makes things easier.”
In addition to the daily job of helping families after a death, the team swings into action during times of disaster, like floods, storms or fires. The team makes sure members who may have suffered losses or been displaced or injured can get help with their medical needs.
Jamie Lund, one of the team’s advocates, said, “Our work goes hand in hand with our purpose — to help our members in sickness and in health. It’s being there for members from birth to death.”