Hello, My name is...
Which QUEST principle does this statement fall under:
"I would be just as frustrated"
What is Empathy?
Name 4 election types.
What is IEP, SEP, AEP, and MADP?
A member has HMO plan - Who initiates the referral for the mm to schedule an appointment to see a specialist
What is PCP?
When a member no longer wants to be active with an Advantra plan and they are already active.
What is Disenrollment?
Define: LEP
What is Late Enrollment Penalty?
"Thank you for allowing me to assist today", is an example of what type of statement?
What is an appreciation statement?
To qualify for a Special Election Period (SEP) the member must meet certain criteria, Name two.
What is moving out of service area, moving into or out of an institution, losing/ gaining credible coverage, qualifying for extra help?
In this plan, the member has the ability to use INN/OON benefits. They can also visit specialists without obtaining a referral.
What is PPO?
When a member cancels their plan they will receive a confirmation of cancellation letter in ____ business days.
What is 7-10 business days?
Define: PHI
What is Protected Health Information?
"We updated your address and changed your PCP. Is there anything else that I can assist you with?", Is an example of what kind of statement?
What is a summary statement?
An election period during which beneficiaries can choose to change Medicare Advantage plans (Part C) or Medicare Advantage Prescription Drug coverage (Part D)? Changes will take effect on January 1st - Include dates.
What is Annual Election Period ; October 15–December 7?
Name that plan: To target any one of three special-needs populations – beneficiaries who are institutionalized, have severe or disabling chronic conditions, or qualify both for Medicare and Medicaid benefits (dual eligible).
What is Special Needs Plan?
Annual Disenrollment Period is a time frame where members can disenroll between these dates.
What is January 1st- February 14th?
Define: EOB
What is Explanation of Benefits?
There are 2 things we must tell our members at the end of EVERY call.
What is "My name is ___, is there anything else I can assist you with today?" and "There is a brief survey at the end of the call."
Beneficiaries that are eligible for both Medicare and Medicaid are referred to as
What is Dual Eligible?
This plan does not require the mm to select a PCP. MM is permitted to go to a participating provider without a referral.
What is Open Access HMO?
A member must have this in order to disenroll from a plan.
What is Special Election Period?
Define: Preventative Services and give one example that would fall under this category
What is Health care to prevent illness or detect illness at an early stage, when treatment is likely to work best?
(for example, preventive services include Pap tests, flu shots, and screening mammograms).
It's important to ask these types of questions in order to assist our members.
What is probing questions?
There are 4 requirements to have a Medicare Advantage plan, name them.
What is be eligible for part A, enrolled in part B, not have pre-existing ESRD, and be located inside of the service area?
Like HMO, this plan requires members to choose a PCP – Like PPO, members are free to see any doctor
What is Point of Service?
There are 4 ways to attempt to disenroll, name them.
What is by filling out the form, writing a letter, calling Medicare, and signing up for a MAPD or PDP plan?
Define: Medicare and give one example of the intended audiance
What is federal health insurance program for: People who are 65 or older, certain younger people with disabilities, People with End-Stage Renal Disease