MOCK CALL PRACTICE: Healthcare Insurance Customer Service | With Call Handling Tips

Hey ninja I hope you're doing well today in today's video we are going to have a mock call practice video for a healthcare / insurance billing improve so if you're ready I'm ready let's begin thank you for calling life member services this is Raya how can I help you today I have a question about something.

I received in a mail sure I'll be glad to assist you with that mail can you please tell me more about the mail you received well you see it's like this couple weeks ago I was involved in an accident and I was rushed to hospital but I feel better now anyways I was under the impression that my insurance or you guys will cover the whole bill.

But this paperwork says something else I am sincerely glad to know that you're all good now I will be happy to check your account so that I can help you better may I have your complete name and member ID Peter board ID number is some six seven five six four six it's May 12 85 3 2 1 first Street no way thank you let me check your account real quick ok.

Ok I've been checking here Peter it shows that a claim for $1,000 was paid last week that was August 12 and that it says that it actually covers your entire bill by the way on that letter that you received on the topmost right part does it say this is not a bill oh well now that you mention it it does say this is not a bill ok that's good to know.

Because what you have there is an EOB or an explanation of benefits it should show the breakdown of the charges and the amount that we your insurance paid for so you see every time a claim is processed you will get that information for transparency see and I truly apologize for the confusion that this letter has cost you.

Ah see that's good because you know I still have some medicine to buy and the last thing that I want right now is to pay another bill I know I understand I'm glad to clear things up for you and again no need to worry about the hospital bill we took care of it for you just take care of yourself okay well okay thank you so much can i address.

Your concerns today yes you have oh I'm just happy everything is paid for yes it is well Peter if there's nothing else thank you so much for choosing life member services you take care and I'm wishing for your speedy recovery thank you now that you've seen a sample call let's.

Talk about the tips and reminders that you need to remember when handling this type of call recently someone emailed me asking whether it is more challenging or more difficult to be in a health care account compared to a telco account now I answered that a telco account might be just as difficult or challenging as a healthcare account it really depends on.

How you look at it but maybe a telco account appears easier because it is more familiar to us it's just about telco you can compare it to globe or smart here in the Philippines the familiarity makes it less stressful in a way that you already know sort of what to expect from the callers but in a healthcare account unless you have.

Really worked in that industry before you don't really have any idea of what to say or what to do or what types of call you will get but that is the reason there is a training period so that you will learn all the necessary things that you need to learn about a healthcare type of call now in that call it's an inquiry call as you remember the caller.

Was asking about a meal that he received and he thought it was the bill that he was supposed to pay when he knew that the insurance company should be the one paying the bill and in this case it is very important to start with empathy in your call we always talk about empathy in all our calls remember that you should always consider feelings first.

Before facts so although the customer was calling about that particular bill he did mention he just got up from an accident and of course that alone is already something that can be challenging or difficult for the customer you don't know exactly what the customer is feeling at that time so you have to bank on your empathy statement.

And forget about saying fake it till you make it because when an accident happens to someone you really have to show that you sincere and genuine in your empathy and that you have to show that with a customer of the color that you care for him or her and that you are willing to help.

On another note talking about empathy just because we are so used to giving it out and sober calls or maybe in our previous accounts or previous companies it might come off as insensitive or not genuine when we say it so this is something we also need to practice beforehand and we also have to sound more natural and conversational when we.

Are delivering our statement our immediate response is to say oh I'm so sorry to hear that I understand how difficult it is for you but let's not go over work with our empathy statement if there's no need to apologize and you don't have to apologize because the customer is already in a difficult or challenging situation at the moment and.

The last thing you probably wants to hear is all apologies or all empathy statements without doing anything so it has to be a balance of a sincere and genuine empathy statement and also your ability to help the customer right away and have a sense of urgency on the matter next is you might encounter a lot of.

Jargons because this is for a house character and a lot of us might not have the experience beforehand but don't worry about that too much because as I've mentioned you will be discussing those things in training so everything will be taught to you and if there is anything that you don't understand of course I always say this don't just.

Pretend that you know it but instead ask your supervisor ask anyone that you can ask about it and make sure that you deliver the correct and accurate information in that particular call since the customer was kind of confused of what he received then of course it is your responsibility to explain to the customer what that mail or paperwork is.

All about and in that case the agent was able to explain that as well and it even resulted to and agreement between the customer and the agent about what the bill or not the bill but what the EOB or explanation of benefits was all about and obviously is your responsibility to let the customer understand what's going on remember that.

In that kind of situation you know the customer might not have the time to read the letter or the mail and might not even have the mental capacity just yet to understand what's written on the letter something I also want to highlight is that most of the time when we receive this type of call you know again and again some agents would just.

Think that this customer is not reading the letter or this customer is not reading paper or anything like that but you also have to put yourself in the customers shoes if you would just came from the hospital from an accident you probably will not have the mental capacity as well to read letters to understand what's on the paperwork or.

Anything like that so be sensitive enough to explain to the customer what it is about even though you know for yourself that yes if the customer could have just read that letter and he could have understood right away but then again the customer needs your help because he is in a challenging situation at the moment and as you remembering the.

Call the customer said he does not want to deal with another bill because he still has a lot of medicines too to buyer to purchase that being said it is very important for you to have a customer centric kind of attitude where and you put your customer in the front and center of everything first and think of it as a situation that might also.

Happen to you and you know for sure that you will also probably not have that strength to go through that situation yourself and as I always say in my mock call videos always make sure to use positive scripting or positive words or even encouraging words I was especially in this type of call and again if you need help with positive scripting I have.

A video about that previously I can link it up there so you can check it out after this video I totally forgot to explain the clean process so just in case some of you are not familiar let me give you any Thea the moment a customer or member gets admitted to a hospital his personal information including his insurance will.

Be obtained in this case an insurance claim is processed the hospital will call the insurance provider or HMO or health management organization examples Maxo care and in telecare here in the Philippines so most likely the insurance or HMO evaluates of the charges that they can cover based on the policy or coverage of the member for example they.

Will either cover all hospital expenses or can be just the hospital room and 50% of the total expenses it depends so in the call when the member reported a paperwork he thought it was a bill he needs to pay but it was actually just an explanation of benefits letter that tells him what charges were already covered or paid by the insurance another.

Thing that you may want to know is the verification or authentication process for this type of call and again each call flow is different from one company to another so you always have to follow the guidelines that are taught to you by your account a lot of healthcare accounts have Z TPS or zero tolerance policies and this applies mostly to.

Authentication or verification procedures so remember to always follow the guidelines given by your account because those are the only guidelines that matter I mean even though I have this mock call flow right now of course this may or may not be applicable to you it this is just a sample call after all so make sure that you obtain the right.

Verification information details and follow the right authentication procedures so that you will not get a CTP or zero tolerance policy warning and this is important because this might cost you your job it is that important in my previous account especially that it's a financial institution we can get fired.

Just for not properly authenticating a customer or a caller so think about that yourself but do not let it hinder your performance or do not let it scare you it's really just a matter of knowing exactly what to do what information to ask and what questions to ask as well this may or may not be a simple contact for you but I hope I was able to give.

You an idea of how it works obviously this is just one of the many call types and they don't be able to give you everything but at least we can start from here if you have any questions at all or if you have comments and topic suggestions matric to comment below in my next video we are going to have another mock call video so tune in and.

Watch out for that as well now if you like this content please don't forget to Like subscribe if you haven't yet and I'll see you on my next one
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