Benefits Inquiry Automation demo
Members, brokers and service staff ask in plain words whether something is covered, what it costs and whether it needs approval; the answer cites the plan document. 1:14
What the demo shows
A member service solution that answers coverage, cost and approval questions from the plan.
Six agents read the member's own plan, their deductible and out-of-pocket so far, the prior authorization list and the provider directory, and put one answer card in front of the representative: covered or not, the member's cost worked out, whether approval is needed and asked for, and whether the provider is in network, each sentence cited.
Transcript
- Benefits Inquiry Automation answers a health plan member's coverage, cost, and approval questions from their own plan.
- Today, the representative searches for systems while the caller waits, and members still get surprise bills.
- Rosa Delgado asks, is an MRI of my knee covered and what will I pay?
- Agents read her plan, her deductible so far, the approval list, and the provider directory.
- Covered, cited a section 4.7 of her plan, with her own cost worked out.
- $350 after her remaining deductible.
- The hospital would cost her $636.
- Prior approval is required and not yet asked for, so Jordan prompts the doctor's office from the card.
- Rosa gets the answer by text, the summary is saved, and she does not need to call back.
- Built on Botminds: agents, data, screens, and governance on one platform.
Transcribed from the film’s narration. Captions are on the player.