Call Handling
if a caller asks about a claim - what should your first question be?
is this regarding medical? dental? rx? vision?
what kind of benefits does Healthy Benefits plus offer? (3 types)
OTC, OTC + Healthy Food, and OTC + Healthy Food + Utilities
Shingles- is it covered?
Important: The Inflation Reduction Act (IRA) was signed into law by President Biden on August 16, 2022. Medicare Part D Vaccines covered by the plan will have a $0 cost-share for adult plan members ages 19+, regardless of the drug tier.
Shingles vaccinations are covered under Medicare Part D, not Part B. Therefore, members must have Part D coverage through either an MAPD or PDP plan.
Shingrix is covered under Part D so the Inflation Reduction Act provisions for vaccines applies. Medicare beneficiaries will have a $0 cost-share for adult vaccines recommended by the Advisory Committee on Immunization Practices and covered under Medicare Part D, including the Shingrix vaccine for Shingles.
Dental claim?
we can help unless you need more details or limitations on benefit exhaustion! (Dental Team)
Are AR's allowed to change contact information without verbal consent from the member?
Negative!
What is the 3 part start?
1. ask how can i assist
2. acknowledge - to make sure i understand - you're calling about xyz
3. assure - perfect, i'd be happy to assist!
(and connect!)
Vision - does UHC cover for non-standard "bells and whistles" to eyewear?
No; limited to 1 pair (standard frames and lenses) per annual timeline (calendar year)
Does LIS apply for Part B and Part D covered medications?
LIS ONLY applies to Part D covered medications.
Part B covered medications will be covered at the plan's standard copay.
Group?
Warm transfer (Employer Group)
Are Providers allowed to update PCP in the system on behalf of the member without consent?
Negative!
What is our branding?
1. start - thank you for calling your dedicated texas team
2. end - on behalf of your dedicated team for the great state of tx (and offer survey at the end)
Hearing - how many levels of hearing aids (tiers) are there? What are they?
4
Silver, Gold, Classic (classic level name-brand hearing aid), & Premier (name-brand hearing aid)
For Part D -
where do you check if a medication is covered under the plan?
Formulary
(tier level, and match with Rx Benefits)
Online issues?
Can help unless member is locked out of account / needs help with 2 step verification (Webtech)
Are POAs the same as AR's?
No
POAs require for legal documentation that is sent in for the member and uploaded to the account and can make decisions / changes to the account as if they were the member.
If you have no access to HAWKEYE - who should we be warm transferring to?
Housecalls (:
Fitness - Where do you go for enrollment / activation codes?
If the member uses insulin, what kind of supplies are they able to have covered by the plan?
If the member uses insulin, they may be able to get:
Warm Transfer (Webtech)
What are the three ways to verify HIPAA?
Name
DOB
Address on file
Who are we not allowed to transfer to (groups that we work with on a daily basis)?
What is the fitness benefit?
The UCard program supports ease of access to Renew Active's no-cost gym membership benefit. A member can simply show their UCard (to scan!) and the Confirmation Code at their first visit to a gym or fitness location in the Renew Active network to access a free standard gym membership. (unlimited)
The UCard program supports ease of access to Renew Active's no-cost gym membership benefit. A member can simply show their UCard and the Confirmation Code at their first visit to a gym or fitness location in the Renew Active network to access a free standard gym membership.
What is the max cost for insulin under Part B for affected members?
When is it acceptable for cold transfer?
NEVAAAAA
If information was brought over via GENESYS (verbal prompt), do you need to verify the three pieces of information?
No - you can just verify that you're speaking to (first name / last name)