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Broker Guide
Blue Shield Spotlight

For Employers, Blue Shield Provides a Full-Service Experience

Blue Shield is committed to making it easy to do business with us, whether you're a member, provider, broker, midsize, or large employer group. 

For employer groups, offering Blue Shield plans to their employees means hassle-free service – from plan administration to helping members use their plan benefits.

And to better support these employer groups, Blue Shield will assign dedicated service professionals between late March and early June. They will be specifically responsible for resolving complex situations that require additional support or escalated issues that have not been addressed to the group's satisfaction. The Client Services Representative doesn't replace but rather expands the options a group has to access service. Front-line support will continue to be provided to groups by billing representatives, eligibility processors and others.

Each Client Services Representative will have a strong understanding of their employer group's particular business needs and will be able to help employers resolve complex issues quickly and efficiently, saving time and administration hassle for all involved. Employers will be able to contact their representatives directly by phone or email, and backup representatives will be available to ensure employers can reach a Client Services Representative when they need one.

For member needs, Blue Shield continually strives to provide the highest quality customer service, which helps employers focus on the needs of the business instead of dealing with health plan queries.

Working from customer service survey results, we've implemented several improvements to the overall customer service experience that enables members to easily find answers to questions and resolve issues through various avenues.

In our customer service call centers, the primary goal is "first call resolution," and our customer service representatives are no longer held accountable for overall call volume.  Instead, success is measured by post-call surveys that allow members to report their level of satisfaction with the service provided.

Late last year we launched an improved Interactive Voice Response system that allows members to find plan information faster and easier through the automated phone system – a system our providers are also able to use to quickly and easily verify eligibility, benefits and claims information.

For members looking for support online, we've made significant updates to our Find a Provider tool to help members locate all types of providers in their area, and the website entry points have all been updated to help members log in and quickly find what they need.

With dedicated service representatives working directly with employers and the improvements to our call centers, automated phone system and website, employers can remain focused on critical business needs while Blue Shield takes care of members' plan needs.

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Legislative Update: Mandate Season in Sacramento

By Tom Epstein

Here comes the onslaught. As we feared, the defeat of comprehensive healthcare reform in the state legislature has created a worst-case scenario for our industry's position in Sacramento. With elections on the horizon and the state budget in crisis, legislators have returned to a tried-and-true approach to show voters they're doing something about healthcare without spending any of the taxpayers' money:  mandates.

If you're a politician, mandates can look like a perfect solution.You get to tell a group of constituents that you are standing up for them against those no-good health plans. You don't have to worry about finding the money to pay for it. And you're isolated from the costs it imposes on employers or families who bear the burden of your largesse.

As a result, legislators are flocking to place new mandates onto health plans, adding new coverage requirements for everything from hearing aids to durable medical equipment. The motivations behind these bills are generally admirable – it is a shame when people find themselves without the appropriate coverage for the conditions they have. 

But mandates are often poorly constructed and counterproductive. Take, for example, one that Governor Schwarzenegger signed into law last year concerning prosthetic limbs. The new law sets up an "all or nothing at all" situation that forbids plans from offering limited prosthetic coverage. Over time, the result of this mandate may be less coverage for prosthetics, as purchasers decide it is just too costly.  That wasn't what the bill's supporters intended, but it's the way things work in the real economy.

There's an important distinction to make, here: it is entirely appropriate for the state to set minimum standards to guarantee that consumers can have confidence that any health plan they buy will meet their reasonable expectations. But over and above that minimum, the market functions best when it is allowed to function freely. As brokers know better than anyone, every purchaser has a different "sweet spot" of price point and coverage level that's just right for them. The more that regulations limit their ability to find that level, the more inefficient – and costly – the market becomes. 

Along with our allies in the California Association of Health Plans and the California Association of Health Underwriters, Blue Shield is working hard to educate legislators about how mandates work – and how they don't. Obviously, we urge all of you to join in that effort and take the opportunity to let your representatives know how you feel on the issue as well.

Mandates might make for good politics, but they are no substitute for real healthcare reform.

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Producer Surveys -- Do They Matter?

Blue Shield is focused on delivering superior service to our producers and customers. To that end, we frequently survey producers and employers to better understand their needs and ensure we're doing all we can to support them.

Sales and account administration management use the surveys to take immediate action on your areas of concern. The input you provide also informs and supports strategic initiatives to improve your experience. For example, your requests for online enrollment and eligibility are driving a redesign of our employer portal, scheduled to launch later this year. 

The surveys are conducted on Blue Shield's behalf by an independent third-party research firm, CustomerSat Inc. To protect your confidentiality, individual responses are never shared directly with the sales team.

We've made producer satisfaction a priority in all areas of our business and we're holding our teams explicitly accountable for your experience. 

If you receive a survey from Blue Shield, please take the time to respond: your candid feedback is critical to our ability to make positive changes. We look forward to hearing from you!

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