MET Escalation Steps
True or False: The Member Escalation Team must take over the call if the member is threatening legal action, DOI, or a CMS complaint.
What is True
When requesting help in MET chat, include these 3 items in the template.
What are Agent’s Question, Caller’s Concern, and Articles Used?
The Ambetter Payment Portal is available in these two languages.
What are English and Spanish?
If a member calls to cancel a 2026 policy before the enrollment file is received, use the Cancellation/Disenrollment Process guidance and ask ________ questions to see if it’s avoidable.
What are probing questions?
A State Based Exchange (SBE) means the state facilitates the Marketplace; the Federally Facilitated Marketplace cancellations/enrollments are handled via this site.
What is Health Insurance Marketplace / healthcare.gov?
An Access to Care issue is any issue that is not resolved and is preventing the member from receiving _______.
What is care?
MET does NOT assist with this type of issue: “Experiencing ______ ______.
What are system issues?
On the “Amount” field in the Payment Portal, you choose between paying the “Current Amount Due” or this option.
What is “Other” amount?
If the cancellation is avoidable, offer to connect the member with this retention-focused team.
What is the Save Desk Team?
This team handles calls from members considering canceling and works to retain membership.
What is the Save Desk?
To double-check information sent from the State Based Exchange (SBE), review the member’s ________ file.
What is the Enrollment (or 834) file?
If agents are asking for assistance, provide assistance and submit feedback in the ___ ______ for unnecessary consult.
What is MET Tracker?
In the Payment Portal, these are the two payment method types.
What are Credit Card and E-Check/ACH?
If the plan is On-Exchange or SBE, the member can be transferred to the FFM or SBE to cancel. If the plan is Off-Exchange, you can do this.
What is submit the request to cancel the plan for the member?
The payment grace period for a plan without APTC is this long.
What is 60 calendar days (or 2 months)?
If the agent can locate correct information in the enrollment file, route to the enrollment team for review using this OMNI intent.
What is Benefits & Eligibility?
For the types of issues MET doesn’t assist with, CSAs should use their ____ or reach out to a Team Lead/Supervisor for help.
What is chat?
After submitting a payment, the confirmation number is used to track the payment in this system.
What is Softheon?
In the OMNI Cancellation/Disenrollment Intent, if a previous request exists, the Open Case Status screen shows this clickable identifier.
What is the Service Object ID?
If a member is being denied care due to an Ambetter error, the CSA can transfer the member to this team to add to the Billing & Enrollment Escalation SharePoint.
What is MET?
Bonus: Members need to allow ___ to ___ business days for processing.
What is 3 to 5 business days?
Before using a CentralPoint article, always verify this so it applies to the Line of Business and the member’s state.
What is the article Audience?
If a member’s PTD shows 1/1/1970, it means this (not delinquency).
What is no Paid Through Date currently stored in the system?
Per the Cancellation Disclaimer, members should allow ___ to ___ business days for cancellation processing (and a confirmation letter follows).
What is 3 to 5 business days?
Prior authorizations for MRI/CT/PET, nuclear stress/MPI, cardiac services and more are handled through this vendor.
What is NIA/Evolent?