IMPORTANT TO REMEMBER
When making the actual follow up call to the consumer CSRs, CSRs should remember the following:
- To speak clearly & slowly so that the patient will understand.
- Keep in mind that a majority of MSI’s consumers are elderly and may be hard of hearing.
- If a consumer asks a representative to speak up, please do so. It may seem as though you are shouting into the phone, but depending on the consumer you may have to speak at that volume to be heard.
The insurance will NOT pay for supplies if a consumer is in any type of the following facilities:
- Nursing Home
- Hospital
- Rehabilitation Center
Exception to this rule is if the consumer is in an Assisted Living Facility.
- If a representative performs a follow up and was told that the consumer is in a facility, we should inform the caller of the following:
- The supplies have to be temporarily put on hold while patient is in the facility because the insurance will not cover the items that will be delivered.
- Once the consumer is discharged and the consent form was received, services can be restarted given that we have everything that we need to restart the order. Ex. Valid RX, state eligibility is ok.
ALWAYS read the NOTES before calling ANY consumer/care manager.
- If you see a note saying “NO AOB, NO ORDER” It means because the AOB is not in, we cannot send the consumer their order.
- If you call the consumer and there is no answer, no voicemail, call all the other contacts.
MAILING OUT AN AOB
When re-mailing the consent form to a consumer, CSRs should be sending all of the following for convenience:
- AOB Form (Consent Form)
- AOB Cover Letter
- Self Addressed Stamped Envelope
CSRs should highlight where the consumer or authorized representative must indicate the date and signature.
COMMON RESPONSES OF CONSUMERS TO THE FOLLOW UP CALL
“I DIDN’T GET IT”
If a consumer states this response explain to them that this form was mailed out to them when they first started services. If MSI did not receive it back from the consumer by the time of the first order, it was put in the box with the patient’s supplies along with other documentation for the consumer. Verify that the patient checked the box and other documentation, if they still do not have anything let them know we are going to re-mail the form with a self-addressed stamped envelope.
“I ALREADY MAILED IT”
CSRs should try and get an exact time frame from the consumer (yesterday, Monday, etc.). If they are unsure have the patient estimate. Be sure to use your judgement on whether or not we should have received the consent form already or not. It depends on where the consumer lives.
Explain to the consumer that we might not have received it, maybe it was lost in the mail. Inform the patient that we will be re-mailing the consent form along with a self-addressed stamped envelope for convenience. If the consumer becomes irate, apologize but explain why we need the consent form back. Usually the consumer will understand and will send the consent form back to us so we could bill their insurance accordingly.
CSRs should ensure that the address we have in our system is verified accurately before sending a new consent form.
“I’M NOT SIGNING IT, IT SAYS I’M PAYING FOR IT”
There is a section on the consent form that reads “If my insurance denies payment, I agree to be personally and fully responsible for payment.” which sometimes causes panic in consumers. CSRs should explain that the consumer would only pay for items that their insurance denied of covering. But if that space is left blank, then it means that the consumer’s insurance agreed to cover the current prescribed supplies, and that they wouldn’t have to pay for anything.
“THEY ARE IN THE HOSPITAL/NURSING HOME”
Anytime a consumer goes into a facility (Nursing Home, Rehab, Hospital, etc.) the orders must be put on hold because the insurance will not cover it.The reason behind this is that the insurance feels that the consumer’s supply should be provided by the facility or institution where they were admitted in.
Instruct the family to contact our office when the patient has been discharged so that we can resume our services.