The 2 most missed items are:
The IRMAA Statement
The Closing Scripts
IRMAA Statement
The following does not populate but must be read verbatim. Save on a sticky note, word doc or bookmark this page to be ready to read at the appropriate time:
"If you are assessed a Part D-Income Related Monthly Adjustment Amount (Part D-IRMAA), you will be notified by the Social Security Administration. You will be responsible for paying this extra amount in addition to your plan premium. You will either have the amount withheld from your Social Security benefit check or be billed directly by Medicare or the RRB. DO NOT pay [the Plan] the Part D-IRMAA."
When to read the IRMAA statement
The appropriate time is shortly after stating:
“The monthly premium for this plan is (Premium) in addition to your Part B premium, if you have one.”
…and immediately before playing the disclaimer recording.
Closing Scripts
This scripting does not always populate and failure to read will result in failed QA reviews. Have the scripting saved/bookmarked and be ready to read at the end of the call.
Your enrollment application for the [plan name] is complete and has been submitted. Once approved by Medicare, your plan will start as of [date].
You confirmation number for this enrollment is [number].
In the next 7-14 days, please watch for important information in the mail. Once your application has been approved, you'll receive your member ID Card and other information welcoming you to the plan.
The number for Customer Service is [see carrier customer service numbers listed below]. They are open from 8 a.m. - 8 p.m. local time, 7 days a week. TTY users, dial 711. From now on, you can call Customer Service if you have any questions.
Carrier Agent Services Phone Numbers
Aetna: 866-714-9301
Anthem: 800-633-4368
Humana: 800-309-3163
UHC: 888-381-8581
WellCare: 866-822-1339
Lumico: 855-774-4491
Next Best practices
Remember - you are speaking to a computer so state things in order, state every verbatim, and include key words that the computer is likely listening.
Let the plates be your guide. Cover every item prompted by the plates and over 90% of QA issues will be resolved.
Read all green verbatim scripting verbatim.
Cover every compliance item on every call, even on subsequent calls that dropped and you, or the shopper, immediately call back.
Say everything out loud for the recording, even if it’s already listed in the Dialer.
Move through the plates in the natural progression of the Dialer as much as possible.
If something is missed or a said erroneously, correct yourself for the recording.
10 Most Failed Items:
Confirm pharmacy network participation including preferred/non-preferred (if applicable).
Verify all personal profile items (Name, Gender, Phone Number, DOB, Residential Address, Mailing Address and County).
Important – Gender and County are the most missed items here, don’t be afraid to ask for the gender for the recording (ie, “for the recording, please state your gender”) – simple.State the following: “You may pay your monthly plan premium and/or late enrollment penalty via automatic deduction from your bank account (ACH), Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefit check, or credit or debit card (CC/DC). You may also choose to pay by mail using a coupon book. If you do not select a payment option below you may be defaulted to Coupon Book.”
Important – Do not shortcut the process for $0 premium situation. This should still be read.State all of the required benefits (Maximum Premium, Maximum out-of-pocket, Urgent/Emergency care, Deductibles for both medical and prescription (if applicable), Inpatient hospital copay, PCP copay, & Specialist copay)
Important – Both In and Out of Network must be stated for each of these benefits.Did the agent accurately identify and document the election period for the enrollment application? – This is critical to ensure the app is processed and the customer’s insurance situation is not negatively impacted.
Unvalidated Rx’s - When we pull the Rx’s using the Rx drug lookup tool, we must read through each medication that pulls up to verify they still take it. Verify the full name of the drug (ie Metoprolol Succinate vs Metoprolol Tartrate), the form of the Rx (capsule, tablet, gel, ointment, etc), the dosage (ie mg, ml, net weight for inhalers including how many inhalers per refill), and the frequency (ie how often do they refill - 30 days, 60 days, 90 days, etc).
If the beneficiary provided medications - did the agent review the benefits (tier level and cost sharing) for the prescriptions with the CUSTOMER?
Important – If beneficiary listed no medications, the agent must instead read the in and out-of-network copays for each tier level on the plan. The plates do not explain this so this is another item you must remember. Write it down or reference this speed sheet.Did the agent ask the beneficiary's language preference?
Did the agent read the disclaimer, if applicable?
Did the agent state the following: "Do you wish to specify a primary care physician now?"
Important – The more commonly missed item is the follow up question: "Are you currently a patient of this provider?”Did the agent offer to collect the beneficiary's medications and review how they would be covered under the plan?
Additional best practices
Rather than trying to memorize everything above, simply let the plates be your guide. Cover every item prompted by the plates and over 90% of QA issues will be resolved.
Read all green verbatim scripting verbatim.
Cover every compliance item on every call, even on subsequent calls that dropped and you, or the shopper, immediately call back.
Say everything out loud for the recording, even if it’s already listed in the Dialer. Imagine you are speaking directly to a QA rep who can only hear what’s happening but cannot see because this is, in fact, what is occurring.
Move through the plates in the natural progression of the Dialer as much as possible to reduce the possibility of the QA rep missing things.
If a mistake is made (ie, you state “This plan is the best”) say out loud “let me retract that statement and rephrase.” Sometimes it is appropriate to speak directly to the recording to cover yourself.
SOA ScriptingClosing Scripts
"I appreciate your time today Genevieve. If you will hold a moment, I am going to transfer you to our Customer Care department to verify your enrollment and help you complete a Health Assessment.
The Health Assessment will ask some basic questions about you and your health. The information you provide may help Wellcare to identify care programs and resources that will benefit you.
May I transfer you? This is the number in case you get disconnected: 833-922-2309."
If yes, then copy the phone number and use a 3-way call by clicking the transfer button at the top of the Dialer.
If no, "That’s no problem! I do want to let you know a couple of things. Our Customer Care department will reach out to you in the next couple of days to see if you have any questions about your plan. We will also communicate when your policy has been approved, which could take up to 7 business days. It’s important that you continue to keep all your current IDs and cards, until the carrier sends over new information.
You will receive a brief, one question survey to rate your experience during this process. We value your
feedback and hope you will take time to complete the survey.
Should you have any questions, you can reach out to our Customer Care team at 833-922-2309 or email them at customercaremc@assurance.com.
Again, thank you for choosing Assurance. It has been my pleasure to speak with you today."
SOA Script
"I want you to know that by talking with me, you are under no obligation to enroll, your current or future Medicare enrollment status will not be impacted, and you will not automatically be enrolled in a plan.” Consent A clear “Yes” must be obtained.
Video Tutorial
Click Here for a short video on how to pass calls compliantly