Delphine keeps a box of tissues at her desk. That may seem unusual for someone in customer service, but those tissues have come in handy more than once.

Delphine works at the Blue Cross NC Store in Greensboro, NC. She says, “The most challenging and rewarding part of my job is helping those members who haven’t yet gotten resolution for an issue. They are frustrated, understandably, and they want immediate answers.”

Delphine is a calm presence who listens, shows compassion, and gets to the bottom of things. “When members come to me, they are ready to release a heavy load,” she says. “Sometimes they are going through something else entirely that ends up coming to light while we’re talking.” 

Such was the case with a Medicare Advantage member whom we’ll call Ms. P. 

Ms. P was given Delphine’s name as a great resource for Medicare members. Ms. P called the center asking for her, but Delphine was with another member. Ms. P then hopped in her car for the 40-minute drive to the center to meet with Delphine in person. 

“She was in a panic when she arrived,” says Delphine. “She had two issues. First, she needed to have a CT scan that had been denied, and she needed help with getting it approved. Second, she wanted to know how to disenroll from her Medicare Advantage HMO plan because she was worried about the possibility of having to see an out-of-network provider.”

Delphine checked the authorization status for the CT scan and discovered a minor clerical error that was causing it to be denied. Delphine made the necessary update – changing the location of the scan – and it was good to go. 

As Ms. P visibly calmed from that news, they addressed terminating the Medicare Advantage HMO plan. And as often happens when Delphine works with members, there was something else entirely that came up.

“It turns out that she had a mass in her mouth that her doctor thought might be cancerous and would require surgery. That’s why she needed the CT scan,” says Delphine. 

“And she wanted to see an out-of-network provider with an expertise in this type of surgery, which is why she wanted to try and terminate the plan. She had the termination letter all typed up.”

“I advised that since there was no guarantee her disenrollment request would be approved, since it was outside of the enrollment period, it might be wise to simultaneously pursue prior authorization to see the out-of-network providers under her current plan – which she didn’t realize was an option. That way, she’d have peace of mind either way.

“I also let her know that the plan she’d been considering instead would cause her to have a much higher monthly premium.” 

Delphine knows these are high-stress decisions. To put Ms. P more at ease, she offered those tissues and took the time to engage Ms. P on a more personal level.

“I asked her about the beautiful oak tree logo on her typed letter. She smiled and told me it was the logo of her company, a farm and wedding venue. She told me the farm had been in her family for generations and that she had been having fears of having to sell it if she got sick and could no longer maintain it.”

By the time Ms. P left, she and Delphine were like old friends and hugged goodbye. They made plans for Delphine to come tour the farm and wedding venue that next week. Delphine said she’d bring one of her famous red velvet cakes – Ms. P’s favorite.

When they got together for the tour, Ms. P had already had her CT scan. “She told me the most amazing news,” Delphine says. “The mass in her mouth had disappeared. It was entirely gone.” 

There wouldn’t be any surgery. Everything was going to be okay. They celebrated the good news with a slice of that red velvet cake.