MOCK-CALL_DEDUCTIBLE
Sandy: Thanks for calling this is Sandy how may I help you today?
James: Hai my name is James I am calling from the doctor’s office and would like to check the claim status for a patient.
Sandy: Which doctor’s office are you calling for?
James: I am calling for General Orthopaedic Associates
Sandy: And what is your telephone#?
James: My telephone# is 1800-999-9999
Sandy: What is the provider’s tax id number?
James: The provider’s Tax ID# is 123-456-789
Sandy: What is the Patient’s member id?
James: The Patient’s member id is U552211
Sandy: Could you please hold for a moment so that I will pull up the patient’s records
James: Yes, please
Sandy: What is the Patient’s name and DOB?
James: The patient’s name is Linda Far and her DOB is 26/11/1995
Sandy: What is the date of service you checking for?
James: The DOS is 03/02/2022
Sandy: What is the billed amount on this claim?
James: The billed amount is $1200.00
Sandy: Could you please hold for a moment so that I will search for the claim?
James: Yes Sandy take your time!
Sandy: Thanks for being on hold James, the Claim was Processed towards Deductible
James: Okay, May I know the claim received date?
Sandy: Claim was received on 03-15-2022
James: May I know the claim processed date?
Sandy: Claim was processed on 03-20-2022
James: May I know the allowed amount on this claim?
Sandy: The allowed amount is $500.00 even
James: Is there any denial or outstanding codes in this claim?
Sandy: No denial or outstanding codes in this claim, also the total allowed amount of $500 was applied towards the member’s deductible.
James: May I know the annual deductible amount for the year 2022?
Sandy: Annual deductible is $3000
James: Could you please tell me how much the patient met in that annual deductible as of this DOS
Sandy: Please be on hold James,
James: Okay sandy
Sandy: Thanks for holding, James I can see the patient accumulated $2600 as of this DOS
James: Thanks Sandy, May I know, this claim was processed towards in-network or out-of-network?
Sandy: Yes This Claim was Processed towards an in-network Deductible
James: Okay, May I know, this deductible was applied to family or individual deductible?
Sandy: This deductible was applied to individual.
James: Does this patient have a family deductible ?
Sandy: No
James: Could you please fax me the eob ?
Sandy: Yes may I have your FAX#
James: It is 877-882-3696 and you can put the attention James in that fax
Sandy: Okay please be on hold I will send this rite now.
James: Okay
Sandy: Thanks for being on hold James, I have sent the fax and it will receive shortly
James: May I know the time when we will receive the fax copy
Sandy: It will reach around in maximum of 2 hours.
JAMES: Sandy may I get the claim#
Sandy: Yes it is VK123456
James: What is the call reference# Sandy?
Sandy: Call reference# is 5587598
James: Thank you so much for your information it is nice talking to you have a nice day Sandy
Sandy: It’s a pleasure talking to you James, you have wonderful rest of your day.
James: BYE.
If the patient already MET or completed the total annual deductible on previous DOS and there is no remaining balance but this claim is still processed towards the deductible! Now, what would you do?
James: May I know the allowed amount on this claim?
Sandy: The allowed amount is $500.00 even
James: May I know the annual deductible amount for the year 2022?
Sandy: Annual deductible is $3000
James: Could you please tell me how much the patient met in that annual deductible as of this DOS
Sandy: Please be on hold James,
James: Okay sandy
Sandy: Thanks for holding, James I can see the patient was already satisfied with the annual deductible and there is no balance in it
James: Okay May I know on which dos the total annual deductible has been satisfied?
Sandy: James the total deductible was satisfied previously on DOS 02/18/2022.
James: Sandy can you send this claim back for reprocessing since this claim should not be processed towards the deductible since the patient was already satisfied with it?
Sandy: Yes James please be on hold I will send this rite now.
James: Okay
Sandy: Thanks for being on hold James, I have sent this claim back for reprocessing.
James: May I know the reprocessing time?
Sandy: Kindly allow 15 business days from today
James: Okay may I get the claim#
Sandy: Yes it is VK123456
James: What is the call reference# Sandy?
Sandy: Call reference# is 5587598
James: Thank you so much for your information it is nice talking to you have a nice day Sandy
Sandy: It’s a pleasure talking to you James, you have wonderful rest of your day.
James: BYE.