Many of the unsung heroes at Cigna Healthcare work behind the scenes, going above and beyond to ensure that access to care is seamless for our members.

In honor of Customer Service Week, which is celebrated every October, we bring you these four stories of customer service excellence.

Helping a customer navigate prior authorization for a new prescription

Nicole Williams-Hall is a pharmacy prior authorization representative who recently helped Gary* obtain prior authorization for a new prescription his doctor had requested.

When writing the prescription, the doctor specified that Gary receive a specific brand-name medication because he had experienced adverse reactions when taking alternatives to that drug. However, his health plan guidelines specified that generic versions be dispensed. Because of Gary’s specific needs and the complications he had faced in the past, he opted to ask his doctor to submit an appeal of the denial for the original prescription.

Williams-Hall worked to make the appeal process as easy as possible for Gary, walking him through every detail – explaining what to expect, next steps, and who he needed to contact. But she didn’t stop there.

She spent time reviewing the alternate drugs listed as options with Gary. They discussed which of these drugs he had previously tried and had adverse reactions to, as well as those he had not yet been prescribed and might be able to try should he be unable to access the prescription his doctor originally requested. When submitting an appeal, providing supporting documentation that demonstrates the medical necessity of the treatment is highly recommended, so Williams-Hall reminded Gary to ensure his doctors were aware of the reactions he had experienced, and to make note of them when submitting the appeal – which was successful.

“You very rarely run into someone like her,” Gary said. “Nicole is wonderful. She’s so pleasant, she explained everything in detail to me, and I wish I could talk to her every time I call.”

Putting a customer’s mind at ease about out-of-pocket costs

When Marco* called to confirm his out-of-pocket responsibility for a recent ambulance ride, he was concerned and curious why the hospital, the emergency department doctors, the pathologist, and the radiology technician had all submitted claims, while he had not received anything from the ambulance company.

Customer service analyst Jeff Grant said that Marco was concerned about receiving a potentially high bill, having heard that ambulance charges can be expensive. Grant was able to ease some of Marco’s worries when he informed Marco that ambulance services for emergencies are treated as in-network care under his plan. 

After finishing his call with Marco, Grant contacted the ambulance service to obtain the status on Marco’s charges. 

“I called the billing company and learned that their normal protocol is to set up a patient account, then submit a claim,” Grant said. “As no account had been set up, no claim was submitted. However, a representative told me the account would be established within two weeks and the first bill sent to Marco within 30 to 45 business days.” 

Grant checked regularly on the matter, then reached out to Marco each time to update him on the status. Less than a month after Grant first spoke with Marco, he saw that the ambulance company’s submitted claim had been processed and the patient balance was available. 

Marco praised Grant for going above and beyond. “On a weekly basis, Jeff had been calling with where things were at, putting my mind at ease, always offering if there was anything else he could help with,” Marco said. “He has been phenomenal to work with.” 

Introducing a customer to her mental health benefits

Before Brandy* checked into an in-patient mental health program, she called Cigna Healthcare for detailed information about her benefit. She spoke with customer service representative Irene Holimon.

“[Brandy] knew what her coverage was for outpatient services but was concerned about her inpatient benefits,” Holimon said. “She wanted to know if it would require a separate authorization, so I informed her that if the facility decided she needed to be in an inpatient setting, they would then reach out to Cigna for approval.”

While that answered Brandy’s question, Holimon did not stop there. She told Brandy about some of other the services that were available to her, including access to Cigna Healthcare’s mental health coaching and to registered dietitians.

“She educated me on a program I didn’t realize was offered,” Brandy said. “She was really knowledgeable and was a big help to me.”

Brandy also works in a call center setting and understands how challenging Holimon’s work can be. “She did a great job asking me what I was saying to make sure she understood,” Brandy said. “I appreciate everything she did for me.”

Guiding a customer with dental pain to the right level of care

Ted* was in pain and thought he needed a root canal, so he turned to his Aunt Lily* for help. “He wanted to see an emergency dentist but did not want to pay out-of-pocket costs,” Lily said. “I wanted to help him contact Cigna and go over his coverage with him.”

With Ted nearby, she called Cigna. Customer service representative Sarah Newton asked Ted for approval to speak with Lily on his behalf, then reviewed Ted’s dental issues and provided information on nearby in-network providers.

“Ted decided his pain was not at emergent levels, but we did find an in-network endodontist and made him an appointment with a general dentist to see if further dental services were needed,” Newton said. Because Ted was nervous about the cost of those services, Newton reviewed the option of dental virtual care. She also explained how an exam would be billed, so there were no surprises.

“Lily was kind and asked a lot of questions on behalf of her nephew in an effort to help him avoid paying any unnecessary costs,” Newton said. “They wanted a provider who was affordable, but also highly rated.”

Ted and Lily were grateful to Newton and for the information she shared. “Sarah is an outstanding customer service representative,” Lily said. “She went above and beyond to find an in-network endodontist for my nephew, told us about how he can see their prices online, and helped us with his prior claims. She was so professional and made sure we had everything we needed.”

 * Names have been changed to protect the privacy of the customers in this article.