Skip to content
March 29, 2024

Helping Plan Members Means Asking Questions as Well as Answering Them

October 26, 2018

Now in her fourth year at VNSNY, CHOICE Member Experience Representative Alfa Dominguez lives in the Bronx with her 14-year-old son and works the phones at the CHOICE Call Center in VNSNY’s 500 7th Avenue office in Manhattan. Her 30 to 40 calls per day may involve anything from questions about benefits to requests for additional HHA hours. She also works in the field for CHOICE’s SelectHealth special needs plan, visiting area hospitals to offer members face-to-face assistance about program benefits.

“We’re the last stop,” says Alfa, referring to the information she and her Call Center colleagues provide for CHOICE members. “When they call for help, if we don’t have the information, we research it and get back to them—we don’t send them anywhere else.”  A primary focus for Alfa’s telephone work involves making sure members understand their benefits and are using them effectively. When Carol (not her real name), a new CHOICE member who speaks only Spanish, called because she’d lost her OTC drug card. Alfa ordered the replacement card, and then talked to Carol about her coverage. Among other topics, she explained that Carol should check in with her primary doctor and that she had coverage for transportation to medical visits. And when Carol mentioned she had pain related to her dentures during the same call, Alfa found a local dentist, confirmed eligibility and made the appointment, setting Carol on course to better-fitting dentures.

“Especially with older members, they can call about one thing and forget they have other questions,” says Alfa. “So I wind up asking themthe questions, to make sure they are getting the preventive care they need to stay healthy. It’s like being a mind-reader and a detective.” If the member’s situation is complex, Alfa will take down several contact numbers to make sure she can reach them wherever they might be. She’ll then research the answer. and get back to them. “If I have to leave a message,” she notes, “I tell them if they don’t reach me when they call back they can talk to anyone in the Call Center—we are all on the same page.”

In addition, says Alfa, “I review with members all of their benefits and take notes about why they went to the doctor, to get an idea about their underlying conditions. If a member is elderly and has trouble understanding their benefits, I’ll suggest that we send them PHI forms that will give VNSNY permission to talk with a family member directly on their behalf. Or, if a member lives alone and seems to be struggling, I’ll ask them ‘Have you considered getting home care so someone can help you with your daily life?’”

Alfa also makes a point of noting in her calendar any pending coverage approvals or action steps for each member, then follows up to make sure the care was received. “I don’t feel like my task is completed until the member is completely satisfied and is able to obtain the services they need,” she remarks. “I feel great at the end of the day, because I did something positive for someone who really needed it.”