GPS
What is the Resources for Living program?
It's a program that helps connect members and caregivers with resources in their community
How many level appeals do we have?
5
What benefit does a bone density test fall under?
Bone Mass Measurement
Give an example of an appreciation statement
Thank you so much for allowing me to assist you today or Thank you so much for being the BEST part of AETNA.
What is LIS?
Low Income Subsidy (also referred to as Extra Help)
Does Medicare cover newborn care?
NO
What is a CTM?
Complaint to Medicare or Call to Medicare
What system do we use to look up authorizations?
Medcompass
What are the PEAS in QUEST?
Paraphrasing, Empathy, Appreciation, Summarize
If the member has LIS level 2 what would be the premium subsidy coverage amount?
100%
What benefit would a wheelchair fall under?
DME
What is a Coverage Determination?
Prior authorization related tp Part D
Where in GPS can you see the Max out of pocket?
Accumulators
Why do we paraphrase?
To make sure that we FULLY understand why the member is calling?
LIS is funded and awarded by whom?
The federal government
If a member's benefit show exclusive for diabetic supplies what brand are they allowed to get that would be covered at 100%
Aetna brand only----One touch/Life scan
What is the turnaround time for a standard appeal pre-service for Aetna to make a decision?
30 calendar days
What two systems do we use to verify if a provider is participating with the member's plan or not?
SFE & RUMBA
If the member does not say anything sad on the call how can we still empathize and make a connection with the member?
By simply saying I know how important it is (EX: I know how important it is to make sure that you have your ID card so I can definitely get one sent out to you.)
SPAP is funded by whom?
Funded by the individual states
If a member is needing to get their toenails clipped and have corns and calluses removed what benefit would that fall under?
Routine podiatry
What is the turnaround time for a standard authorization pre-service for Aetna to make a decision?
14 calendar days
Where would we look to see when a member can leave their plan or join another plan?
On the plan sponsor profile page under enrollment and eligibility
How do we greet our callers?
Hello, my name is _______ am I speaking with the member? May I have your member ID?
or
Hello, my name is ________ may I have your member ID?
If a member has SPAP what out of pocket cost may they get help with?
Deductible, copayments, Coverage gap & Premium (it may or may not include any LEP)