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The Skeptic
You call a 72-year-old patient to discuss their plan options ahead of AEP. They immediately push back.
"Are you trying to sell me insurance? I get these scam calls all the time. How do I even know you're real?"
How would you respond?
I completely understand — you're smart to be cautious. I'm actually calling from One Medical Seniors. We're a primary care practice designed specifically for adults on Medicare. We don't sell insurance at all — we're a doctor's office.
I'd love to share more about our care and help you determine if we are a good fit for your needs — how does that sound?
The Overwhelmed New-to-Medicare Patient
You reach a 65-year-old patient who just became eligible for Medicare. They sound stressed.
"I have no idea what I'm supposed to do. Everyone keeps telling me different things. I don't even know what AEP means."
How would you respond?
I hear you - I'm happy to help.
AEP is the Annual Enrollment Period where all adults on Medicare have the option to enroll, change, or update their insurance coverage for the new year.
Let me refer you to a local trusted insurance agent in your area we refer our patients to. They are more than happy to walk you though your options and how this enrollment period works. Let me give you their contact information, do you have a pen and some paper nearby?
The Loyal Plan Holder
You call a patient who's had the same Medicare Advantage plan for 5 years.
"I've had this plan forever and it works fine. If it ain't broke, don't fix it. Why are you calling me?"
How would you respond?
I'm glad you found a plan you're happy with. Let me confirm we accept your current plan and that nothing will be changing for you in the new year. Have you received your new insurance card yet?
If the plan is going OON in 2027 -
We are reaching out to let you know we will no longer accept your plan in the new year. We'd love to keep you with us for care and support you in determining your options. It's great to check your current coverage for any changes during the Annual Enrollment Period since they can update the plan benefits each year.
An agent would help ensure you are getting the benefits that fit your needs and help you find a plan we accept. Do you have an agent?
The Procrastinator
You reach a patient who knows they need to review their plan but keeps putting it off.
"Yeah, I know I should look at it. I'll get to it eventually. Can you just call me back next month?"
How would you respond?
I'm happy to reach back out to you once you confirm your new coverage for the new year. How can I support you in getting what you need?
Do you have an insurance agent who helps you select your coverage each year? If not, let me refer you to one in your area.
AEP ends December 7th, I recommend getting a head start on calling your insurance or insurance agent to pick a plan that is going to work best for you. The sooner the better to ensure the plan you pick has what you need, then if not, you still have time to make changes.
The Cost-Conscious Patient
You call a patient on a fixed income. They sound worried.
"I can't afford any surprises. Every time something changes, it costs me more money. I'm not touching anything."
How would you respond?
I hear you. I'd love to get you over to an insurance agent who knows the in's and out's to all of the insurance plans, and can help you ensure you don't select a plan that will cost you more. There may even be a lower-cost plan with better benefits than the one you have now, so it can't hurt to check. Let me give you to contact info to a local agent in your area you can trust to ask any questions.
The Visit Decliner
You reach a patient who was assigned to One Medical Seniors as their PCP but has never come in for a visit.
"I already have a doctor I've been seeing for years. I don't know why I'd come to you. I didn't even ask for this."
How would you respond?
Thank you for letting me know. (add lead source if applicable - Looks like you reached out on our website to learn more about our doctor's office.)
We wanted to touch base with you during the Annual Enrollment Period where most Medicare adults make changes to their plan and/or their provider.
I'd love an opportunity to share with you how we could benefit your care in the new year and get you scheduled with one of our providers closest to you, what are your thoughts?
The Winback Patient
You call a patient who used to visit but hasn't been in over a year.
"I stopped coming because it was impossible to get an appointment. What's different now? Why should I come back?"
How would you respond?
Thank you for letting me know. I'm surprised to hear you could not get an appointment, especially since we offer same-day/next-day visits for any urgent needs.
We also now have a patient portal/app where you can schedule your own appointments.
Let me take a look at our appointments, I'd love to show you a better experience and ensure you are cared for when needed. How does that sound?
The "Just Email It" Patient
You reach a patient who doesn't want to talk on the phone.
"I don't have time for this right now. Can you just send me something in to my email? I'll look at it when I get a chance."
How would you respond?
Absolutely, let me collect the best email for you to send your more information.
I'd also love to find another time to connect that works best for you, how about tomorrow, what does your day look like?
(Offer a time frame - ex: between 2-4p)
Also let me give you the best number to call back if you get some free time to reach our team directly...
The Plan Question — Agent Referral
You call a patient who starts asking detailed questions about specific Medicare Advantage plans, benefits, and coverage options.
"Which plan should I pick? What's the difference between all these options? Can you just tell me which one is the best?"
How would you respond?
Great question, there are so many great plans and different benefits dependent on your needs.
Let me refer you to a local insurance agent who can discuss all the different plans and options. You can share with them exactly what benefits you're looking for and help you select the best option.
Let me connect you over to the agent now, please stay on the line.
The Caregiver Caller
You reach the phone number on file, but it's the patient's adult daughter who answers.
"My mom can't really handle these calls. I manage all her medical stuff. Can you just talk to me instead?"
How would you respond?
Current Patient:
Understood. Let me confirm we can speak with you regarding her care. (check 1Life for POA or notes that state the daughter has permission to discuss patient information)
New Patient:
Understood. I do want to confirm we get verbal permission from the patient that it is OK speak with you regarding her care, can you please get her on the line with us?
The "I Already Called" Patient
You reach a patient who sounds annoyed about receiving a repeat call.
"Someone from your office already called me last week. Why do you people keep calling? I already told them I'm not interested."
How would you respond?
Apologies - we received a request for you looking for information about our doctor's office. How has your search been going in finding a primary care provider so far?
I'd love to share more about our office, what we offer, and see if we have a location close to you - what is your zipcode?
The Misinformed Patient
You call a patient who has incorrect information about their coverage and is worried.
"My neighbor told me Medicare is getting rid of my plan next year. I'm going to lose everything. What am I supposed to do?"
How would you respond?
Let's get you over to a trusted insurance agent to confirm your current coverage and plan for the new year. They will be able to inform you of any changes coming up for 2027 and help ensure you stay covered.
You can also always call your insurance directly with any insurance questions. There is a phone number on the back of your insurance card for members.
The "I Want to Leave" Patient
You call a current patient who is unhappy with their experience at One Medical Seniors.
"Honestly, I've been thinking about switching to a different doctor. I don't feel like anyone here really listens to me."
How would you respond?
Thank you for letting me know. Being heard, supported, and cared for is the most important. Tell me more about your experience and how I can help..
OR
What I'm hearing is the provider you have might not be the best fit for you. Tell me, what your looking for in a provider?
The "My Plan Changed" Patient
You call a patient who just received a letter from their insurance company saying their plan benefits are changing. They're upset.
"I just got a letter saying my plan benefits are changing next year. My copays are going up and they're dropping some of my medications. This is ridiculous!"
How would you respond?
I hear you. Unfortunately plans change every year, but during AEP is the time where you have the control to select the best plan for your needs, and find the best benefits. Do you have an insurance agent who helps you select your insurance plan?
If not, I'm happy to refer you to a local agent to discuss your plan options.
The Referral Opportunity
You're on a call with a happy patient who mentions a family member or friend who needs a doctor.
"My husband just turned 65 and he doesn't have a doctor yet. He's been putting it off."
How would you respond?
I hear you. With the holidays coming up it's a good time now to get him scheduled in with a provider. Then he's all set if anything comes up, and he doesn't need to struggle getting an appointment.
Let's see what he's looking for, and find a good time to get him scheduled for a visit so he's covered when he needs us.
OR
I'm happy to reach out to him to share more about our benefits and encourage him to schedule a primary care visit. What is the best number to reach him?