What happens when you call Blue Shield

Growing up in South Africa, Ashleigh Gutierrez saw firsthand how challenging it can be to navigate health care and health insurance with a chronic illness. “My dad was really sick my whole life. From a young age, I remember my parents were always on the phone with their health insurance, instead of focusing on how he could get better,” she says. “They once had to pay thousands of dollars out of pocket because they were sent for some tests at the wrong place, and they ended up not being covered."

As a customer care representative for Blue Shield of California’s Shield Concierge service, Gutierrez spends her time at work making sure that kind of situation doesn’t happen to the members she meets on the phone. “I take my job very seriously because I understand people are calling me for help,” she explains. “I want people to feel like they’re calling a friend, and by the end of the call, it’s my goal to have everything taken care of for them.”

Gutierrez’s “zero homework” philosophy of doing whatever it takes to solve a member’s problem is built into Blue Shield’s unique approach to customer care, where the priority is solving members’ issues completely, rather than quickly.

Before she took a job at Blue Shield, Gutierrez worked as an entertainment coordinator for elderly patients with dementia, organizing activities to keep them engaged and active during the day. But when her husband, who also works in customer care at Blue Shield, told her about an open position, she jumped at the opportunity.

“When I first interviewed with Blue Shield, I fell in love with everything the company stands for,” she says. “This job gives me the opportunity to make sure no other family has to go through what my family had to go through.”

Gutierrez says that the calls she gets from members are often questions she can answer quickly and easily, like requests to change a primary care provider, but she goes beyond just making the change and saying goodbye.

“I try to anticipate anything that could happen, so they don't have to call us again later,” Gutierrez says. “If a member calls asking to change a doctor, I don’t just change the doctor. I call over to the doctor's office to make sure they’re accepting patients. I find the next available appointment and I’ll make that appointment, so the member doesn’t have to."

Sometimes she’ll come across seemingly simple problems that wind up being more complicated than expected. “Just the other day, I had a member who needed to find a doctor that contracted with a specific hospital, which should have been easy to do,” she says. “My colleagues and I spent a couple of hours on the phone calling every single doctor, hospital, and medical group in the area until we found the one she needed.” 

But the moments that really have a lasting impact for Gutierrez are the members who call after they’ve exhausted every other possibility. One case that really stuck with her came in the fall of 2017, while devastating wildfires tore through Sonoma County. “I answered the phone, and this woman says, ‘I don't even know why I'm calling you,’” Gutierrez recalls. “I just said, ‘I’m here, so let’s see how I can help.’”

When the wildfires swept through the woman’s home and community, she lost everything, including the CPAP machine she needed for a medical condition. Every effort she made to get the device replaced had been stalled or blocked, and she called Blue Shield because she didn’t know what else to do.

“That case really hit me hard. I told her that she had been through enough, and I’d take it from here,” Gutierrez says. “I felt like it was my own grandmother who needed my help.”

Within about two weeks, Gutierrez had not only gotten the CPAP machine approved, but she made sure it was delivered to the member. “When we get calls like that, the member’s work should be done,” she says. “That’s what we’re here for, to ease their stress by taking on these problems and sorting them out."

Gutierrez knows that people don’t want to spend their days trying to navigate the complexities of the healthcare system. Simply focusing on their health and the care they need should be their first priority. “Health insurance and health care are so complicated, and I understand how stressful it is to get sick on top of that,” she says. “It makes me happy to tell members, ‘I've got it from here, and I’ll call you back once everything is resolved.’ That’s why I love my job.” 

At Blue Shield, we work hard to respond to all members’ questions and concerns. This is why, along with providing world-class customer service, we have built a digital platform to provide self-service capabilities to all our members. Using our website and mobile app, members can access their digital ID card, check deductibles, and find a doctor, urgent care, or pharmacies nearby.