Random
Samantha calls in because she heard of UHC's offering a plan that had fitness membership in it.What is the term for the extra's that UHC provides to consumers?
Riders
What do you need to satisfy Hipaa for a consumer, witness, and Authorized Rep?
Consumer- first and last name; DOB
Witness/Authorized Rep- Caller's first and last name; Relationship to caller; Applicant's first and last name and DOB
Define IEP; SEP; and AEP.
IEP- Initial election period- 3 month before, month of, and 3 months after 65th birthday.
SEP- Special Election Period
AEP- October- December, effective day is 1/01
True or false: You can jump around in the call flow, its really just a suggestion.
FALSE. USE (clap) YOUR (clap) CALL (clap) FLOW!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Bob just turned 65 and wants to get a plan. He doesn't really travel alot, and his doctor recently retired so he would be looking for a new one. He only sees his doctor a few times a month.
What plan type would you be looking at for Bob?
HMO
What Quality # talks about offering to look up consumer's medications? Is this a high or low point value? What system would you use to look up the medications?
#8; High; DCE
Explain the LIS/Dual Election Periods and when you use each.
Maintaining- 1 time every 3 calendar months.
Change is status- when they first get LIS/Dual, Change levels, or lose LIS/Dual.
Where is the transfer statement located on the call flow? What is the statement provided?
First Decision Point- What I'm going to do for you is gather a little more information and get you pointed in the right direction.
What quality # covers professionalism/ Communication/ active listening? What job aid is listed for help?
#34: Situational Guidelines
Describe each part of the call flow and the goal of each.
Greeting- Hipaa
Determine Eligibility- medicare number and qualifications
(cont)
Nora is calling you, looking to get information on what she should do for insurance. She recently lost her husband and he was the one that dealt with these things. She doesn't really go to the doctor that often. She plans to continue the country like her and her husband had planned. Her Zip is 42301. Kentucky Daviess county. She takes lisinopril 20 mg 1 time a day, and omeprazole 20 mg 3 times a day.
How would you explain the different pieces of medicare and what path would you recommend for her?
--Elevator conversation--
-Medsup+ part D
What do you have to provide to the consumer to pass Quality when it comes to drugs?
offer to look it up; provide Tier, UMs, Initial Costs, and if applicable Total drug cost (only if not covered); Pharmacy status; how many of the drugs are covered.
When do you make your final considerations, costs, wellness benefits, path, ect.
Determine plan Gather
Where can you find Quality information on your call flow? what is on each one?
Gold stars; Read them out loud