What is this
Member is upset that missed appointment
QOC
When documenting is including the doctors full name important
Yes
Members complaining because the Gym staff was unprofessional and hung up on her.
VG - Customer Service
Ohh wow, you finally answered. It took you like 30 min just to answer my call
Member is expressing dissatisfaction due to long hold time.
Member expresses dissatisfaction with the IVR system. Is it Customer service (not telesales) or Digital representative
Customer Service ( not Telesales )
Explanation: The digital representative dropdown is intended for the member's digital experience (such as the app, chat, etc.). If the IVR complaint comes when the member is contacting customer service (not Telesales), advocates should select that option.
Member hates the hold music
VG
When documenting is it important to provide member feelings?
No. Main points from the caller as to what happened
member missed her vision appt due to transportation with Medicaid never showed up.
Transportation/Transportation- Late or no show
Hi. I've been waiting 2 hours for my ride home, where is my ride?
Member expressing dissatisfaction to long wait on ride/ late pick up.
Member expresses dissatisfaction that she went into the hospital and a nurse took her prescription glasses prior to her surgery. The glasses are now lost. Is this a QOC or VG?
VG
Member is upset that provider mis diagnosed him
QOC
When documenting, is it important to add location
Yes. Location of the issue (some doctors have several offices or a facility)
Medication was ordered but still not received
Optumrx/ compliant about optumrx mail order services
Can you put me on hold without the music? I really hate that hold music!!
Complaint about Hold Music
Member expresses dissatisfaction about her Part D medication being out-of-stock at the pharmacy. Is this “Plan – Prescription Drug Benefit (Not Part B).-other” or Pharmacy – Pharmacy Issue - there were processing issues with an order.
Pharmacy – Pharmacy Issue - there were processing issues with an order.
Member is needing their prescription covered
When documenting, is it important to add the time?
Yes. Date and, if possible, the time of the issue
OTC products not received
OTC/ Products and supplies
I'm very upset, I was transferred several times
Complaint about Call Time/Hold/Transfers
Member expresses dissatisfaction that she can't make a follow up appointment with her doctor after having cataract surgery. Member was told the office couldn't schedule her appointment because her plan is showing as inactive. Is this Provider / Facility / Hospital- Unable to get an appointment / refuse to see member - Other or Plan - Plan eligibility - plan effective date is not as expected."
Plan - Plan eligibility - plan effective date is not as expected."
Explanation: Since the crux of this complaint is the fact that the member is incorrectly showing as inactive (which is then leading to the inability to get an appointment), it would best fall under "Plan - Plan eligibility - plan effective date is not as expected."
Member is asking her ventilator to be covered
OD- Organization Determination
When documenting, are we to capture what the member is saying or capturing our option of the situation?
We should be capturing only what member says. not our thoughts on it
Outbound Campaign/ promotional Calls
Plan/Excessive Calls from plan or plan vendor
Member called in expressing dissatisfaction alleging that they cannot access the Optum Rx website.
Complaint about OptumRx website
Member expresses dissatisfaction that her cat's food is not covered under the monthly OTC credit. Is this Plan- Plan Benefits -issues with additional benefits or Plan - Plan benefits - OTC/healthy food and utilities - the benefit requested is not covered by the plan
Plan - Plan benefits - OTC/healthy food and utilities - the benefit requested is not covered by the plan