HEALTHCARE Account Mock Call & Tips for Call Center Newbies

Summary

This video offers a beginner-friendly guide to working in a healthcare call center, explaining the U.S. healthcare system and its key players: members, healthcare providers, medical equipment suppliers, and insurance companies. It describes common call scenarios, such as checking patient eligibility and processing orders, while emphasizing the importance of accuracy, especially when providing insurance details. The video also highlights challenges like emotional interactions with patients and the high standards expected in healthcare accounts. Despite the difficulties, the video encourages new agents to embrace the learning experience.

Takeaways

• 🩺 Healthcare accounts in call centers involve supporting members, healthcare providers, medical equipment suppliers, or insurance companies.
• 👨‍⚕️ The four main parties in the U.S. healthcare system are members, healthcare providers, medical equipment suppliers, and insurance companies.
• 🏥 Healthcare providers include hospitals, clinics, labs, psychiatric facilities, nursing homes, doctors, nurses, and caregivers.
• 💊 Medical equipment suppliers provide items like oxygen, wheelchairs, CPAP machines, and other medical supplies.
• 💼 Insurance companies cover the patient’s healthcare expenses fully or partially in exchange for a monthly premium.
• 📞 In a healthcare call center, you may handle inquiries about patient eligibility, benefits, or medical supplies depending on the account type.
• ⚖️ It is critical to provide accurate information, as insurance companies often have a zero-tolerance policy for mistakes that could lead to serious financial consequences.
• 😠 Calls from healthcare professionals are often less emotional, while calls from patients or members may involve frustration or anger, especially if there are issues with coverage.
• 🔍 Verifying coverage and eligibility is essential in healthcare calls to prevent miscommunication and potential coverage issues.
• 🧠 Healthcare accounts can be complex and emotionally demanding due to the nature of the information and the emotions involved, but they provide valuable experience for call center agents.

Q & A

What is the primary focus of the video?

The video explains the basic foundation of the U.S. healthcare system, the industries involved, and the role of call center workers in a healthcare account.

Who are the four main parties in the healthcare system according to the video?

The four main parties are the member (who holds the healthcare insurance), healthcare providers (facilities and professionals), medical equipment suppliers, and the insurance company.

What are the three possible areas you could work in within a healthcare account call center?

You could work for a healthcare facility or professional, a medical equipment supplier, or a health insurance company.

What should you be cautious about when providing eligibility and benefits information?

You must ensure 100% accuracy, as insurance companies often have zero tolerance for mistakes, which can lead to serious consequences if incorrect information is provided.

What is one downside of handling calls from healthcare professionals?

If a healthcare professional asks for information on multiple patients (e.g., 10 to 20), it can significantly increase your average handling time (AHT).

Why might a patient call the insurance company, according to the second mock call?

The patient may call because their usual doctor or facility is no longer covered by the insurance company, or they might be confused about why their coverage has changed.

What options can be offered to a patient if their doctor is out-of-network?

They can either visit an in-network provider or use their secondary insurance to cover the out-of-network costs, although this may require a co-payment.

What is the process for ordering prescription medications in the U.S. according to the video?

Patients phone the prescription company, which confirms the prescription, and then the pharmacy sends the medication to the patient.

What must you verify before processing an order for medical equipment or medication?

You need to ensure there is a valid prescription on file and that the authorization is not expired.

What are some emotional challenges of working in a healthcare call center?

You may deal with frustrated, angry, or grieving members, which can be emotionally draining as you absorb their emotions during calls.