Aug 17, 2022
Retirees transitioning from their employer’s insurance to COBRA to Medicare, worry about possible hassles. But if they’re working with the St. Louis-based WellFirst Health — Provided by SSM Health Plan — team, they are in for a different experience.
During a visit to her pharmacy to refill prescriptions, a recently retired Medicare Advantage member, ran into a snag: Every time the pharmacist submitted the prescriptions, her file showed her former employer as her primary insurance and Medicare Advantage as secondary. As many times and ways as the pharmacist tried, the scripts just would not process.
The member called broker Nathan White, Axius V.P. of Sales, who sold her the Medicare Advantage policy, to explain her problem. Although it is not typical for a broker to act as an advocate for individual members, Nathan stepped in and called our Broker Relations Managers Joe Layton and Melissa Smith, asking them to troubleshoot a solution.
Rather than referring the member to the customer service line, Joe and Melissa got in touch with the pharmacy to walk them through how to submit the prescriptions under the Medicare Advantage plan, and the scripts ran through successfully – one problem solved – but one medication came back with a very high copay.
The team realized that the prescription was for a name brand drug, which had a generic available but the member couldn’t tolerate it. For some this would have been the end of the story. But after some research, Melissa and Joe found that Good RX offered the medication at a lower price. Problem number two, handled, all within a couple of hours.
This is an ‘above and beyond’ situation, according to Gina Wallis, Director of Sales at the plan, one in which most brokers would normally refer a member to customer service.
“Nathan is the type of broker who provides exceptional care for his clients,” Wallis said. “We are also a plan that believes that we can make a difference locally. I can promise that there are no national carrier reps (same job as Melissa and Joe) who would go out of their way for one member on one issue. But we believe that ONE member is our neighbor. We are a community helping each other.
So ‘above and beyond’ for another plan is what we do every single day – being good neighbors.”
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8/17/22