HEALTHCARE ACCOUNT

Scenario: Appointment Scheduling

Customer: Hello, I'd like to schedule an appointment with Dr. Smith for a follow-up consultation.
Call Center Agent: Of course, I'd be happy to help. May I have your full name and date of birth,
please?
Customer: My name is Sarah Johnson, and my date of birth is May 15, 1985.
Call Center Agent: Thank you, Sarah. Can you provide me with your preferred date and time
for the appointment?
Customer: I'm hoping for a morning appointment, preferably around 10 AM, and any day next
week would work.
Call Center Agent: Great, let me check Dr. Smith's availability for next week. I see that Dr.
Smith has availability on Tuesday and Thursday mornings. Which day would you prefer?
Customer: Tuesday sounds good.
Call Center Agent: Perfect. Now, let's proceed with scheduling the appointment for Tuesday,
next week, at 10 AM. Is there a phone number where you'd like to receive a reminder?
Customer: Yes, my phone number is 555-123-4567.
Call Center Agent: Thank you, Sarah. I've scheduled your appointment with Dr. Smith for
Tuesday at 10 AM. You'll receive a confirmation text message shortly. Is there anything else I
can assist you with?
Customer: That's all, thank you for your help.
Call Center Agent: You're welcome, Sarah. If you have any more questions in the future, feel
free to reach out. Have a great day!
Customer: You too, goodbye!
Remember, the scenario can vary based on the specific tasks and interactions required for the
healthcare account in the call center. This example focuses on appointment scheduling, but call
center agents could also handle inquiries about medical records, insurance, prescription refills,
and more.

INSURANCE
Certainly! Here's a sample scenario for an insurance account in a call center:
Customer: Hi, I need to file a claim for a recent car accident.
Agent: Of course, I'm here to assist you. May I have your policy number and some basic details
about the accident?
Customer: Sure, my policy number is 123456789. The accident happened last Friday, and my
car was rear-ended while I was waiting at a red light.
Agent: I'm sorry to hear that. I hope you're okay. Let me gather some more information. Can
you provide me with the date, time, and location of the accident, as well as any details about the
other driver involved?
Customer: The accident occurred on August 15th at around 3:30 PM at the intersection of Main
Street and Elm Avenue. The other driver was in a silver sedan, but I didn't get their license plate
number.
Agent: Thank you for providing the details. I'll initiate the claims process for you. We'll need to
assess the damages to your car. Are you able to provide any photos of the damage?
Customer: Yes, I have some pictures on my phone. Can I email them to you?
Agent: Absolutely, you can send the photos to claims@insurancecompany.com. Also, could
you let us know if there were any injuries and if a police report was filed?
Customer: Fortunately, no one was injured, but the police did come to the scene and filed a
report.
Agent: That's good to know. Please keep a copy of the police report as it will be helpful for the
claims process. Once we receive the photos and additional information, our claims department
will review everything and get back to you with the next steps.
Customer: Great, thank you for your help.
Agent: You're welcome! If you have any more questions or need further assistance, don't
hesitate to reach out to us. We're here to support you through the claims process.
Remember, this is just a sample scenario and can be adjusted based on the specific processes
and procedures of your call center and insurance company.

Agent: Thank you for calling Member Services. This is Jeline. Who do I have to pleasure of
speaking with today?
Customer: Hello, this is Mary.
Agent: Hi Mary, how are you today?
Customer: I’m doing just fine. Thank you. How about you?
Agent: I feel great. Thanks! And Mary for security purposes, may I have your last name please?
Customer: My last name is Fisher – F-I-S-H-E-R.
Agent: Thank you! And your birthday and zip code please?
Customer: My birthday is June 14, 1957; Zip code is 19344.
Agent: Thank you! I have successfully verified your account and your current balance of S125
will expire on September 30, 2022. How may I assist you today?
Customer: I am calling to place an order.
Agent: Absolutely! I’ll be glad to assist you place your order today.
Customer: Great! I want to order Ibuprofen 500mg.
Agent: Sure. As I’ve checked, we have Ibuprofen 500mg, 50 tablets for S30.
Customer: Yes, that’s what I want. I’ll take that.
Agent: All right. Let me go ahead and process your order.
Customer: Okay.
Agent: And to complete your order, can you confirm your delivery address please?
Customer: Sure. You can shipped it to 87 Roberts Ln, Honey Brook, PA, 19344.
Agent: Thank you! Let me confirm if I got right, that’s 87 Roberts Ln, Honey Brook,
Pennsylvania (PA), 19344. Correct?
Customer: That’s right!
Agent: Thank you! And may I also confirm your mobile number and your email address please?
Customer: My mobile number is 6102737522. And I don’t have an email dear, maybe you can
use my husband’s—
Agent: Sure, that’ll be fine. Thank you.
Customer: It’s markfisher318@hotmail.com.
Agent: Thank you, Mary. I have successfully processed your order. And if you have a pen and
paper ready, I’ll go ahead and provide you with your order number for tracking purposes.
Customer: Yes, I’m ready.
Agent: Great! Your order number is 318-303.
Customer: Got it! Thank you.
Agent: Perfect! And Mary, please expect your order to be delivered on your doorstep two days
from now. Your current balance of S95 will expire on September 30, 2022 and your next
distribution of S125 will be on October 1, 2022.
Customer: All right. Thanks, Jeline.
Agent: You’re most welcome, Mary. And aside from this, would there be anything else that I
could further assist you with today?
Customer: You have covered everything dear, that’s all.
Agent: Awesome! I’m glad that I was able to help you with everything that you need. Mary,
please stay on the line as I transfer you to a brief one question survey. Okay?
Customer: Sure.
Agent: Thank you for calling, Mary. Have a great day!

4 MAIN PARTIES IN THE HEALTHCARE SYSTEM

1. Member
Primary holder
dependents
2. Provider
Facilities and Professionals
 Hospitals
 Laboratories
 Clinics
 Psychiatric facilities
 Nursing homes
 Working in the facilities are the: doctors, nurses, caregivers, medical
receptionists
3. Medical equipment suppliers
Pharmacists
DME (Durable Medical Equipment)
Dental suppliers
4. Insurance Company