Application
What page of the application shows the applicant's personal information such as their name, date of birth, etc?
Page 1
A full health interview is required when?
A person is underage 65 or in WI over 75.
Memory is a valid diagnosis.
True
True or False: Tachycardia is a heart condition
True
The applicant calls and requests to know the reasoning for their application being declined. As a CIT associate, what would be your next steps and what reference materials would you use?
Go to Disposition Cases-Cancellation Requests Document on Sharepoint and follow these steps:
Read the reason for rejection from the letter to the client (typically the second paragraph). Advise of appeal process. If no letter is in file – you will need to go to the disposition screen and read the reason from there.
If the letter OR disposition screen advises that the application was rejected due to information within their claims record / the reason is coded as Claim History (see figures below) you CANNOT give the reason for the decline (such as the condition listed in the disposition screen) only that it was declined due to information in their claims history.
The scrubber's notes indicate the Medicaid question was marked yes, what would be your next steps?
Verify the Medicaid benefits the customer receives. REF132
True or False? You should lead the customer by stating "You take Lisinopril for your Blood Pressure, correct?"
False, you should never lead the customer. You should state, "I see you're taking Lisinopril, can you tell me what you're taking that for?"
Arthritis is a valid diagnosis.
False-we must know the type of arthritis.
True or False: Osteoporosis is inflammation of one or more joints, causing stiffness that can worsen with age.
False, that is Osteoarthritis. Osteoporosis is a medical condition in which the bones become brittle and fragile from loss of tissue.
This means that if the applicant wants to change their plan type, a voice amendment would be required. As we only do voice amendments on cases that we issue and you are not trained on this process, we would simply ignore that note for now.
When the customer answers you notice they do not speak English. There is not a Non-English speaking form in the file. What are your next steps?
If it is determined the client does NOT speak English and there is NOT a note from the scrubber that we have the proper forms, ask the following questions of the person disclosing the information:
What Language does the customer speak? Who translated the application completion to the customer?
Advise the caller we will need to pass this information over to an Underwriter for review and we will be in contact with the producer.
The interviewer should open a “Interview complete task” in UWS with no HFR date. Note in the task the information obtained. Leave all other tasks on case as is.
The interviewer will forward the case to the original scrubber's queue for review. The original scrubber’s name can be found on the activities page in UWS
The applicant calls in and states "My producer, Mr. Smith is on the line too." What would be your next steps?
The producer must not be in the room with them. Even if the client consents to this, we may NEVER do the interview with the producer in the same room or listening in on the line. Kindly explain to the customer and producer that we are unable to complete the telephone interview with the producer listening in. RSK100.1
Thyroid
If the applicant has an implanted cardiac defibrillator or pacemaker, what questions should we ask?
Heart
You receive a case back to your que that has an "Additional Call Needed" task and states we need a dx code for Coreg. True or False: you may contact the client's doctor and request the diagnosis code for them.
False- the client must contact their doctor and obtain the diagnosis code for Coreg. If the client is upset about this do your best to de-escalate the call by stating "I do apologize for the inconvenience, but in order to continue processing your application and make a decision we must have you obtain this information. Due to HIPAA privacy laws, I am unable to obtain this information for you".
Page 2 Section C
True or False? The phone interview may be completed with a POA as long as we have verbal permission from the customer.
False, the phone interview must only be completed with the customer unless given permission to speak with their spouse or significant other.
If an applicant states they are taking Warfarin as needed for "Thinning the blood" What would be your next steps?
How often is as needed? What condition causes you to need a blood thinner? Ask appropriate health questions (Stroke, heart, PVD, etc)
The applicant states they have an upcoming mammogram. Should the underwriter ask additional questions?
Yes, is it routine or for cancer?
Mrs. Smith calls in to do a voice amendment and you notice she is hard of hearing and she is unable to fully understand you completing the voice amendment script. What would be your next steps?
If the client is unable to hear you well enough to do the voice amendment kindly advise the customer you will be in touch with their producer in order to obtain the corrections as this is a legal document that must be understood by the client.
BSP Auth PDF or Payment Information tab in View/Edit in UWS
If an applicant indicates they stopped taking a medication what would be your next steps?
Ask when it was stopped and why? Did they stop on their own, or did their doctor recommend it? Was it replaced with another medication? If so, what was the medication and how long have they been taking it?
The applicant states she is taking Hydrocodone as needed for pain. What would be your next steps?
How often is as needed? What is causing the pain? If arthritis, what type of arthritis and Arth/DBD questions.
During the interview the applicant reveals they had a blood clot in their leg 20 years ago. What if any, questions should be asked?
PAD/PVDT
You receive a phone call and the client states they were told to obtain their medical records and request the address to send these records to. What information would you provide them?
They may fax the records to 402-997-1920 or mail to 9330 State Hwy 133 Blair, NE 68008 with their case number included.