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Archive for March 23rd, 2009

Here is a checklist I wrote for myself to make sure I remembered the basics when taking phone calls for Big Insurance Company. You can see why after all my training, I’ve only just today started taking actual calls. And any abbreviations that don’t make sense are most likely one of the computer systems I’ve had to learn.

PHONE GUIDELINES

Welcome:
– Good morning/afternoon, you’re through to Adrian at Big Company (on behalf of…).
– How may I help you? (TAKE NOTES)
– Name and membership number?
– Thank you, Mr/Mrs. So that I can help you, can you confirm your DOB/post code?
– Third data protection question.
– Take contact number.
– Check Crest: VIP? Need to be transferred? Underwriting?

– Ascertain what they’re calling about. (TAKE NOTES)

If Claims query:
– Check CLA.
– Telephone inquiry and/or VIEW.
– Check comment codes.
– Check practitioner payment interval.

If Pre-Auth:
– Start claim in ACS.
– Condition eligible? (Check SPINE if not sure.)
– DFA. (When enrolled? Suspect period?)
– History. (Pre-existing?) (Seen GP?)
– Referred to someone? (Check in-network.) (Check cap status.) (Check notes.)
– For what treatment?
– Check policy on ACS.
– Check warnings on ACS.
– Check Crest and PAD notes.
– Check Nexus.
– MIF or GP referral needed?
– Where? (If in-network, check hospital.) (Out of network benefits apply?)
– Offer alternatives if needed. (Alliance Surgical, NHS.)

To finish:
– Advise of claim number.
– Advise of letters and forms and the action they need to take. (GP may charge.)
– Advise any limitations on treatment (10/52, for example).
– Remind O/P and excess allowance, if applicable.
– Check understanding.
– Have I answered all your questions?
– Health @ Hand reminder, if applicable.
– Thank you for calling Big Company.

Wrap-up:
– Make notes.
– Send letters.
– Raise promise if needed.

Oy vey.

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