Good Cause Refresher Quiz

15 Questions | By AHSFLTrainer | Updated: Mar 21, 2022 | Attempts: 191

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1.

Listen to the audio clip and then answer the following question.
2.

Listen to the audio clip and then answer the following question.
3.

Listen to the audio clip and then answer the following question.
4.

Listen to the audio clip and then answer the following question.
5.

Listen to the audio clip and then answer the following question.
6.

Listen to the audio clip and then answer the following question.
7.

Listen to the audio clip and then answer the following question.
8.

Based off of the audio clip you listened to, choose which Good Cause matches the scenario: "My Assisted Living Facility takes all of the plans available in my area, but my friend told me that her plan is the best one. She says that out of all of them, her plan offers more extra benefits and covers more services. Can I change to that plan?"
- A.
  
  GC4
- B.
  
  The enrollee does not qualify for a Good Cause plan change at this time
- C.
  
  GC1621
- D.
  
  GC19
9.

Based off of the audio clip you listened to, choose which Good Cause matches the scenario: "My daughter is 17 and she is pregnant. She’s still living with me and wants me to help her through this. The problem is that her doctor refuses to let me back with her whenever they do ultrasounds and wellness checks. This makes my daughter uncomfortable because she wants me there, not to mention that she is still a minor and I am her mother! We want to change to a different OBGYN because of all this, but this is the only provider that accepts her plan in our area. Can we change her plan?"
- A.
  
  GC13
- B.
  
  GC1623
- C.
  
  GC7
- D.
  
  The enrollee does not qualify for a Good Cause plan change at this time
10.

Based off of the audio clip you listened to, choose which Good Cause matches the scenario: "I don’t have a car, so I have to ride my bike anywhere I go. I’ve told my plan this and asked if I could have a PCP that is closer to my home, but the closest providers they offer are downtown. If I had a car, it wouldn’t be a problem, but it takes forever to bike there and back and it’s tiring, especially if I went because I wasn’t feeling well. Can I change my plan so that I can see providers closer to me?"
- A.
  
  The enrollee does not qualify for a Good Cause plan change at this time
- B.
  
  GC1623
- C.
  
  GC1619
- D.
  
  GC1621
11.

Based off of the audio clip you listened to, choose which Good Cause matches the scenario: "I have been paying out of pocket for a month to see my old eye doctor because my plan doesn’t accept him, but he’s the only one I trust to properly assess what treatment I need for my cataracts. He told me yesterday that he accepts a few of the other plans in my area and that I might be able to change my plan instead of continuing to pay. Can I change my plan?"
- A.
  
  GC1621
- B.
  
  The enrollee does not qualify for a Good Cause plan change at this time
- C.
  
  GC1623
- D.
  
  GC9
12.

Based off of the audio clip you listened to, choose which Good Cause matches the scenario: "I’m not sure why, but my plan won’t stop changing my Primary Care and every time to a different location. It’s happened 4 times and seems to happen every other month. I’ve been needing to see a doctor regularly because I have blood pressure problems. Don’t get me wrong, all of the doctors have been really nice, but the problem is that none of them are really able to get to know me or even try to understand what is going on with me before I am changed again. Can I change to a different plan?"
- A.
  
  GC4
- B.
  
  GC1620
- C.
  
  GC9
- D.
  
  The enrollee does not qualify for a Good Cause plan change at this time
13.

Based off of the audio clip you listened to, choose which Good Cause matches the scenario: "I need to have a surgery performed for kidney stones. My provider told me that I need to see a Urological Surgeon for the procedure, but the only one in the area does not accept the plan I have. I tried to ask my plan if they would work with him anyways, but they refused. Can I change my plan so I can have the surgery?"
- A.
  
  The enrollee does not qualify for a Good Cause plan change at this time
- B.
  
  GC9
- C.
  
  GC1619
- D.
  
  GC1623
14.

Based off of the audio clip you listened to, choose which Good Cause matches the scenario: "I want to get my child circumcised, but when it was time for the appointment the Primary Care called me and told me that the plan is refusing to cover any circumcisions because they are morally against it. He told me I would need to change the plan to have my child circumcised. My child can’t continue to go without being circumcised or he will be too old to have the procedure performed, so I need to change the plan as soon as possible."
- A.
  
  GC4
- B.
  
  GC13
- C.
  
  The enrollee does not qualify for a Good Cause plan change at this time
- D.
  
  GC1621
15.

The enrollee states that they have depression and anxiety and were advised to enroll into the specialty plan Staywell. Health track shows that they are locked in and the special condition (SMI) is not on file. Why doesn't the GC17- Move to Specialty Plan show as an option in the drop-down menu?
- A.
  
  The GC17 option will not show because anxiety and depression do not qualify you to have the SMI special condition
- B.
  
  The SMI special condition must be on file for GC17 to show as an option in the drop-down menu. Advise the enrollee to fax in documentation of the condition and provide the fax number for additional assistance
- C.
  
  There is a system error in which the SMI special condition does not always show in HealthTrack. Place the GC17 request on the discrepancy log and advise the enrollee the plan change will be effective the first of the following month
- D.
  
  The GC17 option will not show because SMI is no longer a special condition and there is no specialty plan for SMI
16.

The enrollee is locked in and wants to process a GC plan change because the PCPs through their current plan are too far away. When accessing the case to attempt a GC1621, you see a GC1621 has already been processed recently and the enrollee states they have not received a response. How should you proceed?
- A.
  
  Advise the enrollee that the request must have timed out and offer to file another GC1621 plan change
- B.
  
  Place the plan change request in the discrepancy log so that the GC1621 can be addressed by an offline/resource desk agent
- C.
  
  Advise the enrollee to wait for a response from the Agency for Healthcare Administration and do not process an additional GC plan change
- D.
  
  Advise the enrollee that if they have not received a response it means the GC21 plan change request was denied. Offer to file a complaint
17.

The enrollee is locked in and says: "I just got notified that I have a tumor in my brain. They want to schedule the surgery to remove it immediately because it is putting pressure on very vital areas and causing me a lot of pain. They told me if I don’t get the tumor removed soon I may die. The last time I called, you all told me I had to do some complaint process, but I just don't have time for that. I need the plan changed ASAP!" How should you proceed?
- A.
  
  Advise the enrollee to contact the AHCA Medicaid Helpline to see if they can process the plan change since it is an emergency
- B.
  
  Blind transfer the enrollee to the escalation line so a Supervisor can be the one to tell the enrollee they do not qualify for a Good Cause
- C.
  
  Advise the enrollee that the grievance/appeal process must be completed to file a GC plan change
- D.
  
  Contact SNU to see if a SNU transfer is possible for situations that may be serious or life-threatening
18.

An enrollee is really upset and states they have received a denial letter from an attempted GC9 plan change. Their provider stopped accepting the plan and the enrollee does not want to change providers because this provider has all their medical information and they are comfortable with them. They want to know why it was denied. How should you proceed?
- A.
  
  Offer to file a complaint against AHCA for denying the change and include detailed notes
- B.
  
  Submit the plan change request in the discrepancy log since the enrollee has a good reason to change the plan
- C.
  
  Process another GC9 plan change and add that the enrollee is terminally ill, so the request will not be denied
- D.
  
  Refer the caller to AHCA to find out why the GC9 was denied
19.

An enrollee states, “I just started this plan and already I want to change. The doctor’s office they assigned for me gets so backed up that it takes forever to be seen.” Prior to beginning the Good Cause process, what question should you ask the enrollee?
- A.
  
  “Have you filed a complaint against the doctor’s office? I can process a complaint for you.”
- B.
  
  “Would you like to contact AHCA to ask if they would process the plan change? I can provide you with their phone number.”
- C.
  
  “Have you already contacted the plan to see if they offer any other providers in your area? I can provide you with your plan’s phone number.”
- D.
  
  “Do you arrive on time for your appointments? Sometimes if you are not early, you may have to wait longer to be seen.”
20.

An enrollee states, “I need to change my plan, I have had nothing but trouble with them since I was enrolled. Not only have they changed my Primary doctor four times to completely random locations since I started, but they don’t have any therapists in the plan that can provide the kind of therapy I need to get to recover from my surgery. Other plans provide better care than this! Can you help me?” Which Good Cause should you attempt to process for this enrollee if they qualify for more than one and they have not filed a grievance or appeal with the plan?
- A.
  
  GC1620 because the provider has been changed more than three times to different address locations
- B.
  
  GC1623 because the appeal process will take less time so that the Good Cause can be sent to AHCA faster
- C.
  
  Either GC1623 or GC1620, it does not matter which because both reasons were provided
- D.
  
  The enrollee does not qualify for a Good Cause plan change at this time
21.

An enrollee states, “My doctor just told me yesterday that he is no longer taking my plan and that I will need to switch. I have been meaning to change plans anyways because they keep delaying my prescriptions even though they are supposed to be covered according to the supervisors I speak to with the plan. Can I change my plan?” Which Good Cause should you attempt to process for this enrollee if they qualify for more than one and they have not filed a grievance or appeal with the plan?
- A.
  
  Either GC1621 or GC9, it does not matter which because both reasons were provided
- B.
  
  The enrollee does not qualify for a Good Cause plan change at this time
- C.
  
  GC1621 because the enrollee is experiencing a delay in receiving their medications
- D.
  
  GC9 because it will not require a grievance or appeal with the plan and may be approved by AHCA sooner
22.

An enrollee states, “I need to get two different treatments because I have HIV. My doctor wants to perform them back to back because he says this will considerably reduce my recovery time and will cost less. The problem is that my current plan will only cover one of the treatments at a time. My doctor advised me that both treatments would be covered if I switched to Clear Health Alliance. Can I change my plan?” Which Good Cause should you attempt to process for this enrollee if they have an active HIV span on file, and may qualify for more than one Good Cause?
- A.
  
  The enrollee does not qualify for a Good Cause plan change at this time
- B.
  
  Either GC14 or GC17, it does not matter which because both reasons were provided
- C.
  
  GC17 because they have the active special condition and it does not require AHCA approval
- D.
  
  GC14 because the enrollee needs to have two different treatments performed back to back