Categorization
A new third party company is over charging the member for diagnostic testing
Provider/Prescriber
Provider /Facility Billing complaint
member called in upset because she was told only one dental implant is covered instead of two and she feel both of them should be covered that what she had on her previous plan
One Grievances
Member call and advise her neighborhood pharmacy is requiring an approval for her prescription to be filled and she never had this problem before , What is your categorization ?
Non-Optum Pharmacy
Operations/policies
Transportation driver was extremely rude to the member
VG
Where is UHG Headquarters ?
Minnetonka Minnesota
The member had a last-second emergency and and was unable to make their appointment, but the providers office charged the member a cancellation fee
Provider/prescriber
complaint about provider/facility office policies
Member called in they advised transportation missed their appointment and when they called in to transportation ask about their ride the agent was rude
Two Grievances
Member has attempted to get an appointment to see his PCP but they will not answer his calls , what is your categorization ?
Provider/Prescriber -- Unable to get an appointment / refuse to see member
Member upset because she requested a wheelchair accessible vehicle and transportation sent the wrong type of vehicle and based on her condition she need her wheel chair
QOC
What are the three lines of business that create our company ?
UnitedHealth Group , Optum, United Healthcare
The provider will not schedule the members surgical consultation because of an outstanding bill owed by the member
Provider/prescriber
unable to get an appointment/refuses to see member
Member called in to advise that transportation was late picking her for her doctor appointment and they always late and they never showed up to take her home from her doctor appointment
One Grievance
Member is upset that his provider will no longer be INN, what is your categorization ?
Provider Network -- Provider Not in-network / Distance to Provider
Member got a transportation ride to his appointment but he noticed the driver was not wearing a mask and saw bed bugs crawling on the seats
QOC
What is UHC 2022 Priorities ?
Affordability
High Quality, Supported Care
Simplicity
Transformative Innovation
Our People
The member feels the like the PCP rushed her out of the exam room after her visit
Provider/Prescriber
Provider/Facility Service
Member went into the providers office and she was complaining that there was magazines all over the place and the office was untidy and the receptionist kept coughing.
One Grievance
Member calls in and advises that the broker misinformed them about the plan benefits, what is your categorization
Sales Agent/ Broker
Member went to see the provider and they couldn't find any parking at the facility
QOC
What is UHG cultural values
Integrity, Compassion, Relationships , innovation, performance
The oral surgeon performed the wrong procedure and now the member has chronic jaw pain
Provider/Prescriber
Quality Of Care (QOC)
Member states the facility is filthy, curtains are torn, bathrooms are unclean, bedding is dirty, and there are several types of insects. Member states she is receiving inadequate care. The CNAs are not changing her and have left her in a soiled undergarment for over 3 hours. Member states that these conditions are not good for her health. Member states the nurses and aides do not answer call lights for hours.
Two Grievances
Member calls in and advises you that he has requested his PCP submits a PA for a wheelchair but provider does not, what is your categorization ?
Provider/ Prescriber -- Poor Provider/ Facility Service
Member is dissatisfied that her OTC benefits don't roll over month to month
VG
What are three of the nine roles of individuals (CLL)
1. Execute
2. Work with Others
3. Use Resources
4. Communicate
5. Show Initiative
6. Offer Input
7. Support and Execute Change
8. Demonstrate and Enhance Technical and Functional Expertise
9. Focus on Personal Growth and Development