Notes

TIPS FOR CONNECTING TO MEMBERS
1. REMEMBER MEMBER'S NAMES
2. FIND COMMON GROUND
3. ACTIVE LISTEN
4. ASK QUESTIONS
5. MIND YOUR BODY LANGUAGE
6. RESERVE JUDGEMENT

CALL PERSONALIZATION
-BUILDING RAPPORT

HIPAA
-HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996
-PROCTECTING THE HEALTH INFORMATION OR THE RECORDS / DATA OF THE CUSTOMER ESPECIALLY TO THE UNATHORIZED USER

PHI
-PROTECTED HEALTH INFORMANTION
(18) PHI
Names, Phone Numbers, Account Numbers, Social Security Numbers, Geographic, Fax Numbers, Medical records, All element of Date, Email address, Health Plan beneficiaries, Vehicle Identifiers, Certificate and License Numbers, Urls, IP address, Biometric Identifiers Fingers or Voice Prints, Full Face Photographic Images, Unique identifiers characteristic or code

DEFINE EACH CALLER TYPE
1.AUTHORIZED REPRESENTATIVE
2.DECEASED MEMBER
-IF MEMBER IS DECEASED, THEY MAY AHVE THE LEGALLY DESIGNATED PERSON.
-EX. EXECUTOR/ADMINISTRATOR, TRUSTEE, GUARDIAN, OTEHR THIRD PARTY WITH LEGAL DOCUMENTATION.
3.EMPLOYER GROUP
4.INTERNAL CALLER
-USUALLY WORKS WITHIN THE INSURANCE COMPANY
EX.
-PROVIDER SERVICES
-MARKETPLACE
5.MEMBER
-HAS AN ACTIVE COVERAGE TO THE INSURANCE
6.POWER OF ATTORNEY/GUARDIAN/CONSERVATOR
-AN INDIVIDUAL THE MEMBER GRANTS TO ACT ON THEIR BEHALF.
-IT REQUIRES LAWYER AND NOTARY.
7. PROVIDER- ex. doctors, hospitals
PCP( PRIMARY CARE PROVIDER)
-PHYSICIANS, NURSE PACTITIONER, CHIROPRCTORS, PHYSICAL THERAPISTS

MEMBER JOURNEY
PRE-MEMBER- BEFORE
MEMBER- DURING

FIRST PHASE ( PRE-MEMBER)
1.DISCOVERY -CUSTOMER'S DISCOVERY OF THE BRAND AND THE PRODUCT.
EX. ADVERTISEMENTS, RECOMMENDATION BY FRIENDS AND FAMILIES AND OTEHR MEDIUMS
2.SEEK ADVICE- CX USUALLY SEEK ADVICE ABOUT WHAT PRODUCT AND POLICIES WOULD SUIT THEM BEST
3.QUOTING-WHERE EVALUATING THE POLICY COVERGE OPTIONS AND PREMIUM QUOTES COMES IN
4.BIND-APPROVE THE POLICY ANG QUOTE

SECOND PHASE (MEMBER)
1.PAY PREMIUMS -AFTER BINDING, MEMBER WILL START PAYING THE PREMIUM TO GAIN COVERAGE
-MONTHLY MEMBER RESPONSIBILITY
2.MANAGE-MEMBER'S REQUIRED TO PROVIDE UPDATE PERSONAL DETAILS TO VERIFY THE MEBER'S ELEGIBILITY FOR COVERAGE
3.MAKE CLAIMS-MEMBER'S COVERAGE WILL THEN BE REVIEWED TO SEE IF THE SERVICE THEY RECEIVED/ WILL BE GETTING IS/WILL BE COVERED BY THE PLAN
-EXAMPLE: BILL FROM THE PROVIDER, SERVICE RENDERED,AMOUNT BILLED AND IF APPROVED THE AMBETTER WILL PAY THE BILL
4.RENEWAL/RETENTION-KEEP THE CUSTOMER AND TURN THEM INTO A PROMOTER OF THE COMPANY.

THE MEMBER'S JOURNEY (ENROLLMENT, ONBOARDING, BUILDING RELATIONSHIPS, ACCESS TO CARE, QUALITY TO CARE, CARE COORDINATION, BILLING, MEMBER FEEDBACK)
1.ENROLLMENT
-MEMBR IS WELCOMED
-PROFILE IS SET UP
2.ONBOARDING
-THERE ARE SET COMMUNICATION OUTREACH TIMES AT 30,60,90 DAYS OF ENROLLMENT
3.BUILDING RELATIONSHIPS
-BUILDING RAPPORT
4.ACCESS TO CARE
-EASE OF CONTACTING CLINICS
5.QUALITY OF CARE
-INVOLVES PARTICIPATING PROVIDERS, COVERAGE, PREVENTIVE CARE, AND CARE GAP CLOSUURES.
-MEMBER'S NEED IS BEING MET.
6.CARE COORDINATION
-HEALTHCARE COORDINATION
-SPECIALTY SERVICES, COVERAGE AND BENEFITS, PARTICIPATING SPECIALISTS
7.BILLING
-MEMBER UNDERSTANDS THEIR BILLING, SPECIFICALLY FOR THEIR PREMIUM, AND HAS THEM SET UP ANY AUTOPAY CHARGES.
8.MEMBER FEEDBACK
-WHERE THEY ARE SELECTED FOR THE CAHPS SURVEY

INSURANCE-protect against unexpected financial losses
DISABILITY INSURANCE-protect the income of the insured when unable to work
PROPERTY DAMAGE INSURANCE-protects the insured against losses incurred due to property damage
AUTO INSURANCE -due to automobile accidents
LIFE INSURANCE-in the event of the insured's death
VISION INSURANCE -coverage for routine eye care
DENTAL INSURANCE-routine for dental care or dental care not covered under health insurance

INDIVIDUAL INSURANCE
-a personal policy.
* protection for the individual and dependents
*the individual needs to be insurable- be in the good health
* the individual pays the premium
*the policy holder
GROUP INSURANCE
-company-usually an employer
*protection to the specific group of the people under single contract
HEALTH INSURANCE
-medical insurance
-legal agreement between a customer and a health insurance company
-covers medical and surgical expenses that arises due to illness, injury or accident