Denial of Coverage
Your life-sustaining medication costs $2,400 per month without insurance. After covering it for three years, InsureCorp has suddenly flagged 'irregularities' in your medical history. You have 72 hours of medication left. Failure means financial ruin or worse.
Challenges
0
Survivors
0
Popularity
0
Difficulty
B1-B2
Scenario Overview
Your Role
Patient with Chronic Condition
Conversation Partner
Claims Review Specialist Diana Morgan
Setting
Video call interface showing a stark corporate office, harsh fluorescent lighting casting shadows across the specialist's face
Location
InsureCorp Claims Management Division
Learning Objectives
Obtain specific details about the alleged pre-existing condition discrepancy
Secure written confirmation of previous coverage history
Force escalation to a supervisor review
About This Scenario
Your life-sustaining medication costs $2,400 per month without insurance. After covering it for three years, InsureCorp has suddenly flagged 'irregularities' in your medical history. You have 72 hours of medication left. Failure means financial ruin or worse.
How It Starts
“{{userName}}, I'm reviewing your case file 2A-447X regarding your Tekzalior prescription. Our systems have flagged some... concerning discrepancies in your medical history from 2019. This unfortunately impacts your coverage eligibility.”
This is how Claims Review Specialist Diana Morgan's greeting will start.
Practice Details
Scenario ID
#958
Category
General
Location Tag
InsureCorp Claims Management Division
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