OPENING SPIEL:
Hello, good morning! Thank you for calling AMAPHIL.
This is <YOUR NAME> speaking, how can I assist you?
WHEN PLACING YOUR CALL ON HOLD:
Please stay on the line while I process the LOA. (FOR APPROVAL)
Please stay on the line while I check your inquiry. (FOR CS)
CALL REFRESH/GETTING BACK:
Thank you for patiently waiting.
END OF CALL:
Is there anything else that I can assist you with?
Thank you for calling AMAPHIL, have a nice day!
Hello, this is [Your Name] from AMAPHIL. How can I assist you? (3x)
'I am currently unable to hear any audio on this line. Due to this technical difficulty, I must terminate the call. Please reconnect with us by calling back or utilizing our alternative contact channels. Thank you for your patience.'
Hello good aft/morn this is <MO name> of amaphil. We have received an sms that you pressed customer service. How can i assist you?
May i know whom im speaking with to address you properly?
Okay ms/mr____.
Thank you for trying our 24/7 help service.
Do you have any other questions or concerns?
Thanks again for the opportunity and we look forward to bringing our services to your company.
Please feel free to reach us out if you need anything else. Have a great day!
"We are currently experiencing a higher volume of requests, and this may take a bit more time than usual to complete the approval process. We will update you as soon as the process is complete."
This way, you are framing the situation positively, without revealing potential weaknesses, while still managing expectations and showing commitment to quality service.
When addressing callers utilizing offensive or abusive language, maintain a composed and professional demeanor. Adhere to the de-escalation framework by acknowledging the caller's dissatisfaction without validating the use of inappropriate language. Assertively establish communication boundaries by informing the caller that respectful dialogue is required to proceed with the resolution process.
Most professional environments utilize a Three-Strike Policy to protect agents while attempting to resolve the issue.
Strike 1: The Warning
Action: Acknowledge frustration and set the boundary.
Recommended Scripting:
"I understand this is a frustrating matter; however, I must ask you to refrain from using that language so that I may focus on assisting you."
OR
"However, I am finding it difficult to focus on the details while you are shouting. If we can lower our voices, I can investigate this for you immediately.'"
Strike 2: The Final Warning
Action: State the consequence of continued abuse.
Recommended Scripting:
"I am committed to resolving this for you, but I cannot continue if the language remains disrespectful. If it persists, I will be forced to disconnect this call."
Strike 3: The Disconnect
Action: Terminate the call professionally.
Recommended Scripting:
"Since we are unable to maintain a respectful dialogue, I am ending this call now. Please reach back out when you are ready to discuss this matter professionally. Have a good day."
WHEN BEING PLACED ON HOLD BY THE PROVIDER OR MEMBER
What to say:
"No problem. I’ll stay on the line for two minutes. To keep our medical assistance lines moving for all members, I'll have to release the call if we exceed that time. You may call us back once the necessary information is at hand to proceed with the authorization."
Concerns:
1. How can the procedure be done if there is no approval since I can only give you an estimation of the amount?
- Ask the caller if they have the means to have the exact amount of the said procedure.
- If the caller still refuses to provide the exact amount you can say this spiel:
"To ensure we preserve the member's remaining benefits and prevent any overcharging, we require the exact cost of the procedure. We are ready to issue the approval as soon as the final amount is confirmed."
2. For suspended members.
- Please be advised that the member's account is currently inactive, which prevents us from processing approvals at this time. We recommend coordinating with the account holder to verify their status and receive further assistance."
ACCEPTANCE OF REQUEST SPIEL:
Acknowledgment: LOA Request received, [Client Name].
Status: Processing
ETA for LOA #: [Timeframe]
I'll send it over as soon as it’s ready. Thanks!
NEEDS MORE TIME:
Still on it, [Client Name] Your LOA request is currently being validated. I'm monitoring it closely and will ping you here the second the LOA number is generated. Appreciate your hangtime!
PROVIDING LOA:
"Hi [Client Name]! Your LOA is ready. ✅
Member Full Name: [Complete Name]
Diagnosis/Chief Complaint:
Doctor: [Complete Name]
LOA Number: #️⃣ [Insert Number Here]
Details: 📍 [Provider/Hospital Name]
Procedures: [Procedures]
Covered Amount: [Exact amount]
You’re all set! Let me know if you need anything else. 😊"
NOTE: If the DIAGNOSIS is non-readable
1. Ask the provider DIRECTLY to confirm the Diagnosis from the provider rather than guessing and asking others to read the Diagnosis
Verbatim:
"Thank you for sending the document. Unfortunately, we are unable to understand the given Diagnosis to the member. May I confirm the exact diagnosis for us to avoid reporting a wrong diagnosis in our system."