What is this
Member is upset that missed appointment
QOC
When documenting is including the doctors full name important
Yes
Advocate rude
Call Center/ Advocate-Interaction
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 is requesting extended transportation
OD
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 claims they never saw a provider or received a service on a specific date
Fraud, Waste and Abuse
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.
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 is inquiring why fulfillment is late
not a grievance; just an inquiry
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 needs her NovoLog covered
CD
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 loves her Navigator
Happy- not a grievance