PTP Cannot Determine Templates

Deductible Met and 0% Coinsurance – The remaining deductible is $0.00. Coinsurance is 0%, and OOP with insurance is $0.00. The case was closed to insurance due to OOP being lower than the cash price.

OOP Less Than Cash Price – Remaining deductible (Enter amount) Coinsurance (Enter coins %) OOP with insurance (Enter OOP for the patient). The case was closed to insurance due to OOP being lower than the cash price

OOP Greater Than Cash Price – Remaining deductible (Enter amount), Coinsurance (Enter coins %), OOP with insurance (Enter OOP for the patient). Email and SMS sent with PTP communication. 

Call to Request Email, VM left: Called patient to get the email address to send PTP Communication. The patient did not answer, left a VM requesting a call back to 650-540-9180

Call to Request Deductible, VM left: Called patient to get Deductible since the Third Party System only shows Coinsurance. The patient did not answer, left a VM requesting a call back to 650-540-9180

Call to Request Coinsurance, VM left: Called patient to get Coinsurance percentage since the Third-party system only shows Deductible. The patient did not answer, left a VM requesting a call back to 650-540-9180

Pending Call to PT to Request Email Address, Unable to Call Due to Time Zone: Due to the Time Zone, this case is pending patient outreach to request email address. Will call the next business day and prioritize accordingly.

Pending Call to PT to Request Deductible, Unable to Call Due to Time Zone:

 Due to the Time Zone, this case is pending to contact the patient to get a Deductible since the Third Party System only shows Coinsurance. Will call the next business day and prioritize accordingly.

Pending Call to PT to Request Coinsurance, Unable to Call Due to Time Zone: Due to the Time Zone, this case is pending to contact the patient to get Coinsurance since the Third Party System only shows Deductible. Will call the next business day and prioritize accordingly.

Closed due to Misc. reason: PTP – Unable to work on case since it was Auto closed to insurance due to: [ insert Natera CARE reason here ].

Occasionally, we will encounter cases that have been auto-closed for various reasons. We can use this as a template for such situations. Agents should copy the reason for the auto-closure from the Comment section in Care. Common reasons for auto-closure may include:

• Medicaid-related issues

• Auto-closed due to payor labeled as “OTHER” (clarification needed on this category)

• Auto-closed due to different payors, etc.

This is the suggested template for agents to specify why they did not work on the case. Agents should update Salesforce (SF) with the note and then close it in SF..

Make sure you document LIMS. If CARE doesn’t send an auto-note, please add it manually.

Estimate greater than the cash price –Opt-out for SMS – OOP Greater Than Cash Price – Remaining deductible (Enter amount), Coinsurance (Enter coins %), OOP with insurance (Enter OOP for the patient): Email sent with PTP communication due to Opt-out status for SMS.

Estimate greater than the cash price  Opt-out for email –OOP Greater Than Cash Price – Remaining deductible (Enter amount), Coinsurance (Enter coins %), OOP with insurance (Enter OOP for the patient): SMS sent with PTP communication due to Opt-out status for Email.

We are sending SMS communication if the patient has an Opt-in status. However, if the email address is missing, we also call the patient to gather their email in order to send the communication via email as well. 

The suggested templates are as follows:

OOP Greater Than Cash Price Left VM – Remaining deductible (Enter amount), Coinsurance (Enter coins %), OOP with insurance (Enter OOP for the patient): SMS was sent with PTP communication due to the absence of an email address on file. I attempted to contact the patient to obtain their email, but there was no response. A voicemail was left requesting a call back to 650-540-9180.

OOP Greater Than Cash Price – Remaining deductible (Enter amount), Coinsurance (Enter coins %), OOP with insurance (Enter OOP for the patient): SMS was sent with PTP communication due to the absence of an email address on file. I contacted the patient to obtain their email, and they provided the following address: [ insert patient’s email here ]. PTP communication was also sent via email.

No phone number or email registered:  Unable to contact the patient to obtain insurance information or send the PTP offer due to missing contact details (email and/or phone number).

Opt-Out for SMS and email: Unable to send the estimate as the patient has opted out of both SMS and email.