Notes

RUMBA PASS: Sad1620@ VPN: Sad1620@#CITRIX PASS: Sad1620@ AMPLIFIA PASS: Amplifai1# username: M600811ESS: Sad1620-HR Web: Sad1620@
HR Hall: Pass@0123
ScheduleMON-THURS 6:00-3:00AM | OFF FRIDAY SATURDAY | 
LOGIN 10/30/23 - 9:10 NOT LATE SUWIT - SUIT YANYEL1614! -INTELLICARE

13:08-13:31
TRANSFER CODEHMO CALI -03041-03042-03036SPANISH LINE-27003 AETNA DENTAL-07000AETNA PHARM-99718LANGUAGE LINE- 1357#MENTOR LINE-99641PRICING-03078STATE SIDE- 04052/04051ETECH-16201INDEM-10083
3:51-4:14========================================social security is also member id Opening Spiel:
"Thank you for calling Aetna, this is Anne and I'll be your customer advocate today. May I start by getting your Member ID?"
"Thank you for calling Aetna. My name is Anne and I'll be your customer advocate today."
"Thank you for calling Aetna. This is Anne and I'll be your Health Concierge advocate today."
"Am I speaking with (name ng member)?"
"May I have your name and your member ID please?"
"Are you calling for yourself today or somebody else in the plan?"
"For me to better understand you, may I ask if you can speak more louder and clear"
"For confirmation, may I also know your date of birth for me to pull up your account?"
"How may I assist you today?"
"If I understood you correctly, you would like to know _. Is that correct?"
"Do you have provider in mind?"or  "May I ask the name of your provider for me to check if she/he is INN or ONN so that I can provide you your specific benefit?"
Hold:"I'll be happy to assist you with that. Can I place you on hold you for 2-3 minutes for me to look up the information that you need?"or "Would you mind giving me 2-3 minutes to pull up all the information for you?"
"Can I put you on hold for about 2-3 minutes for me to look up the information that you need?"
• If still need time to hold "I need a couple of minutes, or 2-3 minutes more, to provide you with the information. Will that be okay?"
"Please bear with me while I pull up this information."
Recap:"Aside from (concern), would there be anything else I can help you with?"
• Aetna.com/Health Assessment-"By the way, as I can see here, you're still not registered to our website. You may go to www.Aetna.com to register/login your navigator to check on your benefits, claim information, view your ID card, and finding in network provider. You may also complete your health assessment online"or "As I can see here, you are already registered to our member website, you can login there to check on your benefits, claim information, view your ID card, and finding in network provider"
•If member still not complete the health assessment then:"Also, as I can see here that you haven't completed  your online Health Assessment. I'd like to take the opportunity to encourage you to complete the Assessment which will help to determine  any possible health-risk factors for you. Your confidential assessment generates a personalize health action plan that will include action-oriented programs, information and tips to help reduce your health risks and maintain wellness."
Closing Spiel:"To help us improve, do you have a few minutes to take a short survey regarding the service you received today?"
"If there is no other question, to help us improve do you have a few minutes to take a short survey regarding the service you received today?"
If the member say yes then:
"Thank you for your business with Aetna. I'll connect you to the short survey now."
If no then:"Thank you for your business with Aetna and have a wonderful day. Take care."
Claims transfer: "I do apologize, but I'm still not trained for claims, but I can transfer you over to the claims-trained representative."
Warm Transfer:"Hi, this is Anne from your call partner. This is a transfer/assist call. I'm still not trained for the claims and the member is calling about (concern). "
"I have the claims-trained representative here now. 
"Let me connect you over to the claims-trained representative."

==========================================Resolution:- ask this if the member asking for OB-GYN benefits, Routine examination or regular  consultation?-if sabi CT, mri basta may scan search diag or imaging - member id don't give info even if the other member fam confirm 
 "After reviewing your plan, I'm showing here that your benefit for __ are covered at % after your deductible and  also as I can see here that you haven't met or satisfied your deductible for the _ year"
If nameet na yung deductible:"As I can see here that you've already used your deductible and $ has been applied, meaning you only have $ left to meet before the plan  starts paying the %" 

"As I can see here, for  over the country retail brand is $copay for generic it is $copay and if you choose mail deliver it is a $ copay and for generic mail order it is $copay and for  maximum  supply is 
ALLERGY"As I reviewed your benefits and your in network coverage for allergy test performed in the physician's office is % of the contracted rate, deductible after a $copay. For the allergy injections you're covered at % of the contracted rate with n copayThis will includes unlimited doses of allergen immunology that can be administered per year"
no copay for the injections without a physician visit 
if di pa completed ang assessment"I've also noticed that you haven't completed your online health assessment. Id like to take the opportunity to encourage you to complete the assessment wc will  help to determine  any possible health risk factors for you. Your confidential assessment generates a personalized health action plan that will include action oriented programs, information and tips to help reduce your health risks and maintain wellness"
INFERTILITY KEME-diagnosed with cancer and need chemotherapy, treatment may have trouble in getting pregnant
"I'm so sorry to hear about that. Let me take a look at your benefits  for both chemotherapy and infertility. May I place  you on hold for 2-3 minutes to look that up?"
"Your plan covers chemotherapy at % after deductible. also as i can see here that you've met your $ in network deductible. your % cost share applies to your $ out of pocket maximum. $ has been applied to that maximum"

"your plan has infertility coverage the plan covers artificial insemination, ovulation induction advance reproductive technology, cryopreservation storage for sperm, eggs or embryos at % once you meet the $ deductible. there's a $ lifetime maximum for these services. "
"AETNA  has a clinical policy bulletin, number 0327__ that you can review with your doctor to make sure the services you decide to have done  meet the medical criteria. also, before you can start infertility treatment, you'll need to enroll through optum fertility program and  precertification is required i can also provide you their number as well
phone number is 866-935-5355 if you'd like I can text u both the phone number and the clinical policy bulletin info, I just need to let u know that standard text messaging rates would apply
Note: the maximum  is not per service
MATERNITY-hip surgery at hospital, talked to doctor and not yet approved- need to reach out to patient management department,. provide the phone number 888-333-4432
-your in network benefit for the hospital surgeon and anesthesiologist is % after your deductible  since you've met you $ deductible you'll only be responsible for your % coinsurance
oral surgery-ask CPT code if meron-upon checking here  on our end , it appears that this would need to be reviewed by our oral maxillofacial;  surgery dpe
due date November pregnancy 
probe-                                5961248459223344                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
As I can see here that this claim was process as INN participating with standard benefit. For the type of service is it durable medical equipment 
Also as I can see here that your claim was processed with the correct out of pocket level of benefit ,as I've checked that the  allowable amount is already satisfied 
this claim was a preferred benefit because it was billed by a participating provider=========================================*v17-check the original action code sa general claim upper part 
*Updating COB-delete the old COB if no other insurance or even if there is other insurance -ask the mm the details -if no other coverage termination date should be 12/31/9999
*Checking route list rumba-ewmp, route list -F11 to see the details-F10 to go back -Shift F12 to message and include the NID of the sender -Shift F6 to finish========================================number of route list ROUTELIST_DATE KINDLY CHECK YOUR ROUTELIST AND MAKE SURE TO CLEAR YOUR ROUTELIST TODAY 
PUBLIC WEBSITE|STATE SPECIFIC PLAN THE PROVIDER WILL BE CHANGE |SPEC========================================BREAST PUMPAUTHORIZATION INPAT|MED COMPAS THERE IS AUTHORIZATION|BENEFIT INPAT|
10.208.55.10
villarcampo seiton - sheila 
SUWIT|9964