Call flow

Opening : Thank for calling Humana, This is Mike your healthcare advocate. How may I help you?

MM's concern : I just want to check if my insurance covers frame for my glasses.

Acknowledge and paraphrase mm's concern

I know choosing frames is exciting—it’s always nice to find something that fits your style.

Verify : ask for mm's member ID, name, date of birth, zip code

" do you happen to know your current plan? "

Thank the member for authenticatiung the account .

Must provide to the customner Member's Plan Medicare Advantage PPO Effective Date 1/1/2026 Termination Date 12/31/2028 Status Active Benefit Period Calendar Year

Guidance Alert. "I see you're filling in some medications at Centerwell Pharmacy. You're free to use any in-network mail-order and retail pharmacy."

Rapport : As I gather information here. How's your day going so far?

I’m glad to hear that! It’s always nice when the day’s going well. As I gather the information you need, I’ll make sure everything is clear and easy for you.

hold if necessary

In-Network Coverage "$150 allowance, then 20% off the rest of the cost."

“Your plan gives you a $150 allowance toward frames. That means Humana will pay up to $150 of the cost. If your frames cost more than that, you’ll also get 20% off the remaining balance. For example, if your frames are $200, Humana pays $150, and you get 20% off the remaining $50.”

Out-of-Network Coverage " You pay 100% of the cost." “If you choose a provider who is not in Humana’s network, the plan does not contribute to the cost. You would be responsible for paying 100% of the charges yourself.”

Notes One pair of frames per 24-month period. The allowance is the maximum the plan will pay. You’re eligible for one pair of frames every 24 months.

Aside from checking if your ins urance covers frame for your glasses. I just want to make sure that I have covered everything, is there anything else that i can help you with?

If that's the case Thankyou for your time and for choosing Humana we're always here to help Enjoy the rest of your day. Bye