Recently, one example involved an oncology member who is traveling three hours to the nearest treatment facility, only to be informed that this facility is out of network. When Mamie looked into this, she was unable to verify through Find Care if the facility was in network or not, so she reached out to our network management team, who informed her that both the provider and the facility are in network. Mamie then took it upon herself to call the treatment facility on behalf of the member and informed them that, according to network management, they are actually in network. The facility told Mamie that when they contacted Customer Care, they were informed of the opposite—that they’re out of network—and required the member to sign a document stating they were out of network, meaning he would be charged accordingly. This facility attempted to negotiate with GEHA to be paid as if they were in network but were denied. When Mamie called, they requested a reference number for the call and written confirmation that both the provider and the facility are in network. Mamie then reached back out to network management to determine who could contact this facility and confirm that they are in network and that the member can receive treatment there under plan benefits. This took a significant portion of Mamie’s day, and not once did she complain or express frustration about working outside her scope; she simply took charge, dedicating her time and all necessary means to ensure that this member could proceed with his care without delay and with the correct information. While waiting to confirm whether this facility was in network, Mamie even searched for closer facilities or housing accommodations for this member since he was traveling so far.

 

Mamie models empathy daily in every interaction with both members and staff. She reaches out to any and all departments, working collaboratively with the entire company, and with outside facilities if needed, to ensure our members receive the care they require.

 

She makes our members feel seen; she listens to them—even when they are upset and need someone to vent to. Although these conversations can be challenging and take a toll on her, Mamie handles them with grace, consistently prioritizing what is best for our members. I can’t tell you how many times members have commented on how wonderfully supportive she was during times when they needed it most.