Smmc Good Cause New Hire Practice

10 Questions | Total Attempts: 42

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Smmc Good Cause New Hire Practice

Questions and Answers
  • 1. 
    Caller is locked in and says: " I never picked this plan!  You all put me in it!  My doctor, that I really like, doesn't take this plan and has never taken it!  I've been with the same doctor for years, I don't want to change."  Which GC would apply?
    • A. 

      GC17

    • B. 

      GC1622

    • C. 

      GC4

    • D. 

      GC9

  • 2. 
    Caller is locked in and says:  "I have three surgeries that need to be performed consecutively on my spine but my plan only covers the first two. My surgeon advised me all three procedures would be covered under a different plan. Can I change my plan?"  Which GC would apply?
    • A. 

      GC1620

    • B. 

      GC9

    • C. 

      GC4

    • D. 

      GC14

  • 3. 
    Caller is locked in and says:  "I have HIV and my doctor told me to change to Clear Health Alliance, I need that to start soon because all of my new specialists take that plan."  You verify an active HIV span in the case. Which GC would apply?
    • A. 

      GC4

    • B. 

      GC17

    • C. 

      GC9

    • D. 

      GC1622

  • 4. 
    What should we make sure the member has done before attempting to process a Good Cause plan change?
    • A. 

      Ensure the member has called the AHCA Medicaid Helpline to file a complaint.

    • B. 

      Ensure the member deserves a plan change.

    • C. 

      Ensure the member has contacted the plan first to see if the issue could be resolved.

    • D. 

      Ensure the member is 18 years or older.

  • 5. 
    Members that change with a Good Cause Reason get an additional 120 days to try out the new plan.
    • A. 

      True

    • B. 

      False

  • 6. 
    Caller is locked in and says:  "I just got notified that I am a candidate for a kidney transplant.  I need to change the plan because the surgeon doesn't take my plan.  They want to schedule the surgery ASAP, because my kidneys are not working and the dialisis treatment is not working anymore.  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. 

      Tell the caller they must complete the grievance process first, before the Good Cause can be submitted to AHCA.

    • B. 

      Tell the caller they must wait until open enrollment to change the health plan.

    • C. 

      Refer the caller to the AHCA Medicaid Helpline for an exemption.

    • D. 

      For extreme circumstances, submit a supervisor task to verify if the SNU needs to review the issue. In the meantime, advise the caller to contact the plan case manager.

  • 7. 
    Caller is locked in and says: "I need to change my plan as soon as possible. This doctor is the only provider in the area that accepts my plan and my condition has actually worsened under their care. I have documentation to show my condition has significantly worsened. Can I change my plan? Which Good Cause can you use?
    • A. 

      GC9

    • B. 

      GC4

    • C. 

      GC1620

    • D. 

      GC17

  • 8. 
    Caller is locked in and says: The only provider in my area that takes my plan is over an hour away. My friend sees a doctor right around the corner from me but that doctor doesn't accept my plan.  Can I change my plan so I can see a provider closer to me? Which Good Cause would you use? 
    • A. 

      GC4

    • B. 

      GC1622

    • C. 

      GC17

    • D. 

      GC1612

  • 9. 
    Caller is locked in and says: "The company that delivers my meals told me they will stop taking my plan next month. I really like them because they are always on time and they make good food. Can I change my plan to a plan they will take?" Which Good Cause would you use?
    • A. 

      GC4

    • B. 

      GC17

    • C. 

      GC9

    • D. 

      GC1622

  • 10. 
    Caller is locked in and says: "My plan has changed my doctor seven times in the past year, so I haven't been able to really get comfortable with any of these providers. Can I change my plan? Which good Cause can you use?
    • A. 

      GC1622

    • B. 

      GC1620

    • C. 

      GC17

    • D. 

      GC1621

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