Opening - Enrollment Period Validation
A1 - Prepared for the Call
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B1 - Requested Identification, verified and entered information into system accurately
Needs Analysis - Asking for the Sell
Enrollment Disclaimers - End of Call
Greeting: Hello, thank you for calling Aetna Medicare. My name is_________ I am a Licensed Agent; how can I assist you on this beautiful day? (Inbound only) _________________________________________________________ Recap the caller’s situation to confirm understanding: I understand that you are calling to ________________________. I will be more than happy to assist you with that, but first I would like to gather some information from you. Name_________________________________ Phone ________________________ Address ______________________________ St_______ Zip _________ • Current Member: □ YES □ NO Member Number: __________________ Email Address (Read Disclaimer) __________________________________ Set the Call Expectations: • I need to ask you a few pre-qualifying questions to see if you are eligible to enroll today. • We can go over your Medications, Pharmacies, Doctors and Hospitals. • By the end of our conversation you will have all the information needed to enroll with us today! • How does that sound to you? Qualify the Caller: Remember you are verifying this info with the caller; this info is in Rumba. • Has Medicare: □ YES □ NO Medicare Number: __________________ Part A Effective Date: ____/____/____ Part B Effective Date: ____/____/____ • Current Coverage & Type:____________________________ End Date:_ _/ _/____ Date of Birth:_ _/ _/____ • Medicaid □ YES □ NO LIS/Extra Help □ YES □ NO Level: __________ ESRD □ YES □ NO • SEP – Special Enrollment Period □ YES □ NO Build Caller’s profile in CNRx: Medications(Offer to look up medications) □ (Confirm medication e.g. Losartan or Losartan/hctz.) • Rx Name: ________________________ Dosage: _____________ Quantity: ______________________________ • Rx Name: ________________________ Dosage: _____________ Quantity: ______________________________ Pharmacy: Ask the caller which pharmacy they are using and use the CareSource pharmacy locator to find pharmacy • Pharmacy: ___________________ Location: _____________ In Network: ___________________ Providers(Offer to look up providers) □ Primary Doc: ______________ __________ Location: ________ _____ In Network: ____ _______________ Hospitals (Offer to look up hospitals) □ (Provided 3 in-network hospitals.) □ Paraphrase & Suggest Plan: (Quote Most Cost-Effective Plan) Based on what you told me, I recommend the _________________ plan. I will mail you the plan information. I will also be providing you with an Authorization Code to access that email. • Review Plan Details • Plan Name & Premium Amount • If the caller has Extra Help give price before and after, if applicable • Medical and Prescription Deductible (Read exactly as seen) • Pharmacy Status (Preferred, Standard, or Out-of-Network) • PCP & Specialist copays • ER copay- Make sure to state ‘If admitted within 24 hours the ER copay is waved’ • Urgent care & Inpatient care • Quote Medications (Use general tiering information if caller does not take medications) • Check for Utilization management (Step therapy, Quantity limit, Prior Authorization) • Don’t forget to mention: • Dental • Vision • Hearing • CVS Mail Order *** (Assume the sale and roll right into the application!) *** Based on what you have told me this plan sounds like the right fit for you, let’s go ahead and get your application completed for you today! (Stop talking let the caller respond) If the caller declines the offer to enroll, provide a rebuttal. “What’s holding you back from enrolling today? What questions or concerns can I address?” (Close the sale) I am glad you decided to join the Aetna Medicare family today, let’s get you enrolled! Complete the Application Process (Read Required Disclosures) • TE Checklist (Read Verbatim) • Fill out Application CNRX and CTI Script • Read ALL required disclaimers • Review Entire Application (State that you are going to review the application) • Play Audio Disclaimerss, if it does not play, it can be read, please read it and move forward! • Get Verbal Consent from caller to submit application • Provide Confirmation Number (Ask caller to repeat) • Read entire call closing (Thank the caller, branding, hours of operation, telephone number) Is there anything else I can assist you with today? Full Branding: Thank you for calling Aetna Medicare. Have a great day.
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