Plan Coverage, Primary Care Physician, Benefits: (Name of The Person)

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PLAN COVERAGE, PRIMARY CARE PHYSICIAN, BENEFITS

 Hello, Good Morning, this is Andrea from United Healthcare. How can I help you
today?
 Great, we are happy to help you with that (Ma’am or Sir)
 May I know if I’m speaking with the patient or are you calling on behalf of the
patient?
 Thank you.
 And just for verification, May I have your complete name and policy number to
verify your account holder please?
 Alright Ma’am/Sir, Thank you for providing me with that information ,that’s (name
of the person) and your policy number is __
(265-747-7)
 Let me just go ahead and pull up your chart. Would you mind putting this call on
hold for a minute or two while I’m pulling up your chart?
 Thank you for waiting, Ms/Mr._______ (name of the person)
 As I look into your plan coverage, your plan type is silver premium.
 Your primary care physician is Dr. Dani A. Moonstar (MD-Doctor of Medicine), the
address of your doctor’s clinic is 565 N. Mt. Vernon Avenue, Arcana California,
92411.
 The benefits that are included in your account are Annual Flu Shot, Blood
Pressure Program, Annual Physical/Wellness Exam, and House Call.
 Is there anything that I can help you with Ma’am/Sir?

RECAP: Just a quick recap before we end the call, I have helped you regarding
______, is there anything more I can help you with?

CLOSING SPIEL: Alright then, thank you very much for calling United Healthcare.
Again, this is Andrea, have a great day!.

HOSPITALIZATION (PARTNER FACILITIES OR NON-PARTNER FACILITIES OF


UHC)

(If they mentioned a name that is not listed here, that is considered as non-
partner facility/non-covered)

 Hello, Good Morning, this is Andrea from United Healthcare. How can I help you
today?
 Great, we are happy to help you with that (Ma’am or Sir)
 May I know if I’m speaking with the patient or are you calling on behalf of the
patient?
 Thank you.
 And just for verification, May I have your complete name and policy number to
verify your account holder please?
 Alright Ma’am/Sir, that’s (name of the person) and your policy number is __
(265-747-7)
 Let me just go ahead and pull up your chart. Would you mind putting this call on
hold for a minute or two while I’m pulling up your chart?
 Thank you for waiting, Ms/Mr. _____(name of the person)

(Liabilities or medical expenses that is not a partner facility of United Healthcare, the
United Healthcare cannot cover that for you.)

 Thank you for bringing this to our attention, but we regret to inform you that the
clinic you mentioned earlier is not a United HealthCare partner facility. Therefore,
we cannot cover the medical expenses or liabilities.
 I understand how you feel. But please is there anything that I can possibly help
you with Ma’am/Sir?

RECAP: Just a quick recap before we end the call, I have helped you regarding
______, is there anything more I can help you with?

CLOSING SPIEL: Alright then, thank you very much for calling United Healthcare.
Again, this is Andrea, have a great day!.

OFFICE VISITS (Include Medical check-ups and requests of prescriptions)

MEDICAL CHECK-UP

 Hello, Good Morning, this is Andrea from United Healthcare. How can I help you
today?
 Great, we are happy to help you with that (Ma’am or Sir)
 May I know if I’m speaking with the patient or are you calling on behalf of the
patient?
 Thank you.
 And just for verification, May I have your complete name and policy number to
verify your account holder please?
 Alright Ma’am/Sir, that’s (name of the person) and your policy number is __
(265-747-7)
 Let me just go ahead and pull up your chart. Would you mind putting this call on
hold for a minute or two while I’m pulling up your chart?
 Thank you for waiting, Ms/Mr._____ (name of the person)
 Upon checking your account Ma’am/Sir, I would like to ask first; do you have a
pen and paper with you?
 Great. Because I will be telling you important details regarding your check-up.
 Just to clarify you need a check-up under______ (name of the clinic), so please
look for your doctor (assigned doctor’s name) which is Dr____. This clinic is
located at this address _____ (clinic address). If you’re going to ask sub-
questions, please contact their telephone number______. And kindly do that
during clinic hours from _____ (time) so that they can accommodate you.
 Do I need to repeat that again for you Ma’am/Sir?
 Alright, we can certainly schedule that for you. Do you have a preferred dates or
times for the appointment?
 Excellent. I have a few options available next week. How about Monday
November 27 at 2pm?
 Great. I will go ahead and schedule the appointment for you.
 Is there anything that I can help you with Ma’am/Sir?
 You’re Welcome (Name of the person). We look forward to meeting you on
Monday, November 27 at 2pm. Please be there at least 15 minutes early so that
we can check you in. If you have any further questions before you visit, don’t
hesitate to give us a call.

 RECAP: Just a quick recap before we end the call, I have helped you regarding
______, is there anything more I can help you with?
 CLOSING SPIEL: Alright then, thank you very much for calling United
Healthcare. Again, this is Andrea, have a great day!.

OFFICE VISITS (Include Medical check-ups and requests of prescriptions)

 PRESCRIPTIONS- (already out of my painkillers. can you help me?)

 Hello, Good Morning, this is Andrea from United Healthcare. How can I help you
today?
 Great, we are happy to help you with that (Ma’am or Sir)
 May I know if I’m speaking with the patient or are you calling on behalf of the
patient?
 Thank you.
 And just for verification, May I have your complete name and policy number to
verify your account holder please?
 Alright Ma’am/Sir, that’s (name of the person) and your policy number is __
(265-747-7)
 Let me just go ahead and pull up your chart. Would you mind putting this call on
hold for a minute or two while I’m pulling up your chart?
 Thank you for waiting, Ms/Mr._____ (name of the person)
 Upon checking your account, Ma’am/Sir, I would like to ask first; do you have a
pen and paper with you?
 Great. Because I will be telling you important details regarding your prescriptions.
 You were prescribed Mefenamic Acid as your painkiller, it said here that you need
7 tablets and you need to intake 1 tablet per day for 7 days, you will also gonna
charge 5 dollars in your account.
 Do I need to repeat that again for you Ma’am/Sir?
 Excellent. We do have 2 options; We have Home Delivery and Store Pick-up. I
would like to explain the details first, so you can decide which do you prefer.
 For Store Pick-up, these are our partner pharmacies that they can go through,
in order to get their medications, we have “Walgreens, Rite Aid Corporation,
Safeway, and Costco Pharmacies”.
 For home delivery, please expect medication to be delivered within 24 to 48
hours.
 What do you prefer Ma’am/Sir. Home delivery or Store Pick Up?
(Store Pick-up- I would like to repeat our partner pharmacies, we have
Walgreens, Rite Aid Corporation, Safeway, and Costco Pharmacies”. So, you will
know where you will pick up your medications.
(Home delivery- I would like to ask if you’re willing to wait? Because you will
expect medication to be delivered within 24 to 48 hours. Great. I would like to
verify your home address. May I ask what is your home address? So that we can
process your order right away. Great. Thank you for providing that information
Ma’am/Sir ___.

 Is there anything that I can possibly help you with Ma’am/Sir?

RECAP: Just a quick recap before we end the call, I have helped you regarding
______, is there anything more I can help you with?

CLOSING SPIEL: Alright then, thank you very much for calling United Healthcare.
Again, this is Andrea, have a great day!.

BILLING INFORMATION

Question: (WHY THEIR CURRENT BALANCE AMOUNTED TO 580 DOLLARS


WHEN THE MONTHLY PREMIUM IS 280 DOLLARS)

 Hello, Good Morning, this is Andrea from United Healthcare. How can I help you
today?
 Great, we are happy to help you with that (Ma’am or Sir)
 May I know if I’m speaking with the patient or are you calling on behalf of the
patient?
 Thank you.
 And just for verification, May I have your complete name and policy number to
verify your account holder please?
 Alright Ma’am/Sir, that’s (name of the person) and your policy number is __
(265-747-7)
 Let me just go ahead and pull up your chart. Would you mind putting this call on
hold for a minute or two while I’m pulling up your chart?
 Thank you for waiting, Ms/Mr._____ (name of the person)
 Upon checking your account Ma’am/Sir, you were enrolled to Dental and Vision
Stand alone benefits last September 1, 2020. Because of that there is an
additional 150 dollars on top of the member’s monthly premium. Technically,
instead of 280 dollars per month, its gonna be 280 dollars plus 150 dollars.
 Please let me know if my understanding of your problem is accurate.
 Is there anything that I can possibly help you with Ma’am/Sir?

RECAP: Just a quick recap before we end the call, I have helped you regarding
______, is there anything more I can help you with?

CLOSING SPIEL: Alright then, thank you very much for calling United Healthcare.
Again, this is Andrea, have a great day!.

CLAIM AND APPEAL

 Question: (WHY THEIR (number) GOT REJECTED?)

 Hello, Good Morning, this is Andrea from United Healthcare. How can I help you
today?
 Great, we are happy to help you with that (Ma’am or Sir)
 May I know if I’m speaking with the patient or are you calling on behalf of the
patient?
 Thank you.
 And just for verification, May I have your complete name and policy number to
verify your account holder please?
 Alright Ma’am/Sir, that’s (name of the person) and your policy number is __
(265-747-7)
 Let me just go ahead and pull up your chart. Would you mind putting this call on
hold for a minute or two while I’m pulling up your chart?
 Thank you for waiting, Ms/Mr. _____(name of the person)
 Upon checking your account, the reason why number ____ got rejected because
based on its remarks it has ____ and for the second one it’s because the
authorization letter has a missing signature.
 Please let me know if my understanding of your problem is accurate.
 Is there anything that I can possibly help you with Ma’am/Sir?

Question: (WHAT ARE THE STEPS FOR FILING AN APPEAL?)

 I would like to ask; do you have a pen and paper with you?
 The steps for filing an appeal are first, (read the 5 steps)
 Do I need to repeat that for you Ma’am/Sir?
 Great. Is there anything that I can possibly help you with Ma’am/Sir?

RECAP: Just a quick recap before we end the call, I have helped you regarding
______, is there anything more I can help you with?

CLOSING SPIEL: Alright then, thank you very much for calling United Healthcare.
Again, this is Andrea, have a great day!.

DEPENDENT’S INFORMATION

 Hello, Good Morning, this is Andrea from United Healthcare. How can I help you
today?
 Great, we are happy to help you with that (Ma’am or Sir)
 May I know if I’m speaking with the patient or are you calling on behalf of the
patient?
 Thank you.
 And just for verification, May I have your complete name and policy number to
verify your account holder please?
 Alright Ma’am/Sir, that’s (name of the person) and your policy number is __
(265-747-7)
 Let me just go ahead and pull up your chart. Would you mind putting this call on
hold for a minute or two while I’m pulling up your chart?
 Thank you for waiting, Ms/Mr.____ (name of the person)

Question: (Hi, I enrolled my daughter early this morning. I received that it was
successful but nothing is popping on my end. How come?)

 Upon checking our policies, newly enrolled dependent information will reflect
within 24 to 48 hours.

Question: (About HMO CARD)

 The dependent’s HMO card will be delivered within 5 business days.

Question: (How many dependents can be enrolled?)


 You can enroll 3 dependents.

Question: (If they want to enroll a Dependent)

 If you want to enroll a Dependent, May I have your complete name, date of birth,
the relationship of dependent to the account holder and your contact number
please.

 I just want to repeat the details regarding the dependent you enrolled. His/Her
complete name is _____, Date of Birth ______, The relationship of dependent to
the account holder is____ and your contact number is ___. I would like to ask is
that correct Ma’am/Sir?
 Great. Thank you for providing me with that information. Is there anything that I
can possibly help you with Ma’am/Sir?

RECAP: Just a quick recap before we end the call, I have helped you regarding
______, is there anything more I can help you with?

CLOSING SPIEL: Alright then, thank you very much for calling United Healthcare.
Again, this is Andrea, have a great day!.

LETTERS OF AUTHORIZATION (A guarantee letter from United HealthCare that the


member’s medical expenses will be covered)

 Hello, Good Morning, this is Andrea from United Healthcare. How can I help you
today?
 Great, we are happy to help you with that (Ma’am or Sir)
 May I know if I’m speaking with the patient or are you calling on behalf of the
patient?
 Thank you.
 And just for verification, May I have your complete name and policy number to
verify your account holder please?
 Alright Ma’am/Sir, that’s (name of the person) and your policy number is __
(265-747-7)
 Let me just go ahead and pull up your chart. Would you mind putting this call on
hold for a minute or two while I’m pulling up your chart?
 Thank you for waiting, Ms/Mr._____ (name of the person)

 Upon checking your account, Regarding for request for a Letter of Authorization, I
would like to request the following details. May I have your member’s complete
name, policy number, email address, name of the facility, and member’s contact
information.
 Thank you for providing me with that information. An email and SMS notification
will be sent to facility and member four hours after submission of request.
 Is there anything that I can possibly help you with Ma’am/Sir?

RECAP: Just a quick recap before we end the call, I have helped you regarding
______, is there anything more I can help you with?

CLOSING SPIEL: Alright then, thank you very much for calling United Healthcare.
Again, this is Andrea, have a great day!.

**

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