Outcomes
Used when a member is unable, busy, or refuses to verify themselves.
Contact- Member requests a callback at a later time.
ACW Allotment
2-5 mins MAX - only 4- 5 mins for validated phone calls- Left VM should be under 1.5 mins.
Where are you calling from?
I am calling from UHC.
HIPAA
MUST verify DOB/Name
Used when the phone rings for 45 seconds to 1 minute, and no one picks up, and no voicemail or voicemail is full.
DNC-No answer, no VM.
When the family reports a member is in hospice.
DNC-Member in Hospital/SNF/TCU.
Communication with supervisor
SOD/EOD - IT issues- Request time off/ call outs- KEEP EMAILS OPEN
Why would I want to schedule this, I am fine?
Even if you’re feeling fine, scheduling regular check-ups helps in early detection of any potential issues and ensures you maintain your good health. It’s a preventive measure to stay ahead of any possible concerns
Discloure
Must Read Recording disclosure to everyone who enters the line.
ONLY USED IF MEMBER VERIFIES THEIR NAME AND DOB AND YOU READ THE GLOBAL OPT OUT DISCLAIMER.
Global Opt- Out -
Used when a member had a future appointment set ( needs to be validated when you hang up with the member
Contact-Member reports that an upcoming appointment has been scheduled.
Call Outcomes
Covers dispos of call
How do I know this isn't a scam?
Your safety is important to us. I assure you we are not a scam I am calling you on behalf of United Health Care. If you have any questions about <your/his/her> plan, please call the Customer Service number on <your/his/her> Member ID card.
Authorized Rep
MUST be on file, or they have to call Mem services to add someone or update.
Used when family or members state they are in a nursing home permanently.
DNC- Member permanently placed in nursing home.
Used when voicemail is left.
DNC-Left VM-
Deceased Members
Must report MEM ID and click deceased in Five 9
I speak for my spouse.
I understand you are taking the call on behalf of (insert member name), but for this specific health screening, we need the member on the line, or Mr./Ms. (insert member name) can give verbal permission for me to speak with you on their behalf. This precaution is taken to protect their privacy and information under HIPAA and other privacy laws. I hope you understand.
Third-party speakers ( NOT AR)
Must have mem verify themselves and give permission to speak on their behalf.
Used when a member reports an appointment and you call the provider, and that appointment was validated. ( member is NOT on the phone with you).
Contact- Validated complete appointment.
Used when a member no longer has this number or has never had this number. THIS IS NOT USED WHEN A SPOUSE’S OR FAMILY MEMBER’S NUMBER- THEY HAVE TO CHANGE THAT WITH MEMBER SERVICES, AND THAT IS A CALLBACK OUTCOME.
DNC-Wrong Number.
Make Calls
First call should be made within 6 mins of logging in.
I think you called me before to make an appointment.
We very well may have. We are continually reaching out to our Members. Since this is such an important aspect of health maintenance, we’re calling to assist you with setting that appointment. I would like to assist you in getting that appt scheduled. Are you ready to call your doctor together?
Hang ups
You must not end the call prematurely (unless the mem is abusive)
Used when a member is physically unable to speak ( i.e., stroke, trach, dementia, autism, etc.) NOT used for napping, not home, or refusing to speak to us.
Contact-Refused Member INCAPABLE of speaking to the caller.