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Medical invoice pdf for Technical Support

if you're a newbie in a healthcare account and you have zero idea what it's all about this video is for you i will discuss the basic foundation of the healthcare system in the u.s the industries involved and everything you need to know as a call center beginner working in a healthcare account so what is healthcare what do you do in a call center healthcare account for you to understand this you first need to know the four main parties in a healthcare system and they're the following we have of course the member uh this is anyone who has a healthcare insurance it could be the primary holder or it could be the dependents in the provider side we have the health care facilities and the health professionals these are the hospitals the labs the clinics the psychiatric facilities the nursing home working for these facilities are the doctors the nurses the caregivers the medical receptionist and more the next providers on the list are the medical equipment suppliers so these are the companies that provide the medical equipment to hospitals we have here the pharmacy which supplies the medication we have the mde companies these companies provide the oxygen cpap pulse oximeter wheelchair crutches you get the point and the fourth party here is the insurance company now of course the insurance company covers the medical needs of the patient if she wants to have a consultation if she's sick and she's hospitalized she needs medication she pays a monthly fee to the insurance company and the insurance company in return will cover those bills for her fully or partially so these are the four parties in a health care system in short if you are informed that you're going to be working for a healthcare account there are three possibilities you could be working for a facility or a health professional you could be working for a medical equipment supplier or for a health insurance company depending on the patient's needs the insurance the medical supplies supply companies and the health professionals and facilities are going to talk to one another they're going to talk depending on what the patient needs sometimes the patients could also be calling one of the companies here the patient could also be calling the insurance to ask about her coverage could be calling the medical supply companies to ask for her medical supplies or she could be calling the hospital or the clinic or the doctor to set up an appointment and today i'm now going to show you four mock calls these are just simple basic mock calls just for you to get a glimpse on how it is working in a healthcare account and the common issues and increase that you're gonna get on a daily basis let's begin hi thank you for calling with sean healthcare this is candice how may i help you hi candace this is chris from vineyard hospital calling in to check on a patient's eligibility and benefits hi chris i'll be happy to assist you just to remind you this call is being recorded for quality and training purposes may please have the patient's date of birth and full name his name is lucas alfred lucas with a k date of birth january 14 1958 thank you let me just check that here okay i see here that the patient is active with christian health care effective date january 1st 2021 end date december 31st 2021. dme supplies are covered and the authorization and prescription are needed to obtain benefits all right is there any future determination on the account there's no future determination no got it thank you that's all i need for today thank you for calling christian healthcare have a great day thanks bye the call they just heard was a nurse calling the insurance company to inquire about a member's eligibility and benefits this call is pretty easy because all all an agent has to do is to pull up the account give the information needed by the caller and then hang up the phone um it's also easier because you're talking to a health professional not to the member when you talk to health professionals there will be less irate calls because their goal for calling is really just to get information they're usually not emotionally loaded the only downside here is if someone from the doctor's office calls and asks for information about 10 to 20 patients this could really hit your ahd or average handling time so that's a downside of it but if you want less irate calls this is probably what you want to be working for by the way when providing information about a patient's eligibility and benefits you need to be extra careful that you're providing the 100 accurate information and that's because most companies most insurance companies when you provide the wrong information about a patient's coverage they have zero tolerance policy which means that if you make a mistake if you made a mistake you're out because imagine the damage that you're gonna make if you tell a patient or a doctor that hey this patient is covered fully covered only to find out that only 50 of that bill is going to be covered so it's going to be too much drama if there's a mistake so you have to be very careful there are less irate calls but you have to pay really close attention to accuracy now another example thank you for calling question healthcare this is candice how may i assist you today so i'm here at the clinic right now my son is about to have his consultation but one of your representatives told the nurse here that you're not covering the fee today i'm confused my entire family has been visiting this facility for the past five years and now all of a sudden you're saying that they're not affiliated with you i don't get it can you explain absolutely i will be happy to check your account for you by the way this call is being recorded for quality and training purposes may please have the patient's date of birth and full name joshua garcia date of birth january 21 1995 he's my son thank you let me just pull up his account one moment i see here that your account has a primary insurance with us effective date january 1st to december 31st 2021 yeah i know that but your company is saying that has not covered yes i will definitely check that here for you may i know the name of the facility and the doctor's name and the his npi oakwood medical clinic uh dr elizabeth smith npi is triple three five five one three four thank you let me just check that here okay i see here that the facility oakwood medical medical clinic is in in-network as it turns out though dr elizabeth is an out-of-network provider that is why the previous representative informed you that we cannot cover his yes yes you already told us that but i mean why my husband and i regularly come here for checkups we never had to pay a dime don't you think it's strange that we have to pay now yes yes i understand it's a little confusing if that was the case with your previous consultation it means that the previous doctors he consulted were among our in-network providers as it turns out dr elizabeth is out of network i can however suggest two options for you oh yeah what's that so one option is that is to visit one of our affiliated doctors in your area this could take time or if it's this is an emergency you can use your son's secondary insurance with health lift it i can see it here that under health lift he has a coverage for out of network providers although it comes with an eighty dollar co-payment eighty dollar co-payment no thanks why pay 80 when we could have it for free it's not an emergency anyway forget it you know what we'll just head over to the affiliate doctors i'm tired he's tired five years i've been with you and you never once informed me that not all doctors are affiliated with this clinic i mean wow yes this is why it's highly advised to check a doctor's affiliation prior to an appointment because a facility could be affiliated but some doctors may not well now i know bravo is there anything else that i can help you today that's all i'm done it's barely any help but hey what can you do right you only work there bye in this mock call the agent is working for an lob or a department where you mainly talk to members and patients not to health professionals and this is where a lot of irate calls happen because if there's a bad news the one who suffers the most of course is the member or the patient so it's just to be expected that you will get a lot of irate calls here in fact in this mock call the customer was annoyed but i wouldn't describe her as irate she was just disappointed annoyed but there will be harder calls that a member just couldn't accept that she's not covered and you're gonna be stuck on the phone for a long time now what if you work for a medical equipment supplier hi thank you for calling questron pharmacy this is candice how may i assist you today hi candace this is damn um i'm calling in to place an order for my monthly medication i'm running out can you help me out sure i'll be happy to assist you by the way this call is being recorded for quality and training purposes may please have your full name and date of birth so um my full name is stan that's s-t-a-m smith and my date of birth is may 18 1977. thank you stan let me pull up your account okay can you verify the name of your prescription with the reference number of your last order this is for my um albuterol for my nebulizer and the reference number for my previous order is n for no e for eagle b for boy dash three three four five six seven dash one two thank you i see here that we have a valid prescription on file you are on your third month of medication am i right yes that's right so um if i order today when do you think can i get my delivery you will receive it within one to two days okay okay uh that that's fair enough i should still have enough remaining for the next two three days that's fine perfect uh by the way can you verify your shipping address my address is unit 156 elm street elm that that that that is e-l-m-e egg look and money elm street and uh riverside california zip code nine five six three two two three four five thank you so okay i will now process the order for your albuterol expect the delivery by mail within one to two days from 10 am to 5 pm got it thank you so much candice you're most welcome is there anything else that i can assist you with today no i'm good you've been very helpful thank you and you have a great shift ahead bye thank you for calling christian pharmacy you have a great day bye again another simple call it was just a patient asking for a prescription refill by the way the prescription process here in the philippines is different from the us because here when a doctor prescribes a medication he gives us a piece of paper right and we head over to the pharmacy and get the medication but in the u.s if your medication is covered by your insurance uh what you usually do is phone your prescription company that's the pharmacy and your pharmacy is going to get proof that you were indeed prescribed that medication and once that's that's confirmed they're going to send you your medication if you work for a prescription company or a medical equipment supplier you need to make sure that before processing an order there is a valid prescription on file and that the authorization is not expired you're going to talk a lot about this in during the product training because in this account it is imperative that you confirm everything it's better to over verify than not verify at all it's very dangerous not to verify now another example hi thank you for calling questron medical supplies this is candice how may i assist you today hi this is ashley i'm calling in to order diapers and underpads for my patient alice sure i'll be happy to assist you with that uh just to remind you this call is being recorded for quality and training purposes may please have alice's full name and date of birth sure it's alice guzman alice for alice in wonderland um guzman g for golf u z for zed m for mother a and date of birth october 11 1948 thank you let me pull up her account here one moment okay i see that the authorization on file for her in content and supplies is already expired last month on july 31st oh really i i wasn't informed about that by her brief caregiver um okay uh what do we need to do uh in this case uh please call her doctor and ask for a reauthorization that reauthorization request will be sent by her doctor to alice's insurance company and once her insurance approves it her doctor will fax it over to us her medical supply company and after that you can already give us a call back to place the order for her diapers all right okay um oh by the way she needs three more additional packs of diapers per month because the last quantity we had the previous caregiver said that it wasn't enough to last for a whole month okay let me just check that here it shows here that the quantity of the diapers we're providing her currently is the allowed a monthly quantity by her insurance but if you really need to increase it please coordinate with her doctor to get a prescription for increasing the quantity of on the rx he would also have to provide a medical justification as to why the patient needs more than the quantity that the insurance is currently allowing okay so in short i just need to call her doctor to increase the quantity plus the reauthorization correct correct yes all right i will call her doctor right away great is there anything else that i can assist you with today i'm good thanks bye thank you for calling questron medical supplies have a great day bye as you heard it was a caregiver calling on behalf of the patient to order her monthly diaper supply he she also wanted to increase her quantity so the agent just informed her how to go about it how what to do to get to get a renewed authorization a reauthorization on file and to how to increase the quantity of the diapers per month all right so those are my examples as you probably noticed these are just simple and complicated mock calls because the purpose of this video is to just show you the setup of the hell of the healthcare system in the us and to just get a basic understanding before you dive in to your product training but about the terminologies the processes i did not talk so much about them in this video because you're going to learn them in the product training and the processes are going to vary from company to company just know that if you're a assigned in a healthcare account you're going to be working for the health professionals or the health healthcare facility the insurance company or the medical equipment supplier so you're going to have to prepare for those but in my next healthcare account video i'm going to be showing you a more difficult set of mock calls with emphasis on call handling so stay tuned healthcare is probably one of the most complex difficult accounts out there because first of all you're going to be memorizing a lot of information that's that's information overload plus the emotion if you're going to be talking to members that's going to be the hard part there frustration is the least of it anger grief those emotions that you'd rather not deal with on a daily basis you're gonna be absorbing them like you're a sponge and of course the third is there's usually there's a zero tolerance policy which means if you make a mistake a major mistake you're out again this is a complicated account you better prepare yourself physically mentally emotionally psychologically all leads out there you have to prepare for honestly if you have if i have to choose between a retail account and a healthcare account i would choose retail every time but hey that's just me the harder it is the more you're gonna learn the better you experience you're gonna get so don't don't shy away from these challenges um just know that a lot of agents have worked for this account and they were thankful for the experience so just try it undergo product training see if you can do it um try the nesting period and see if this account is for you if not then hey experience all alright that is all for today if you have any questions comment down below if you have any requests comment down below bye