Member Services — call screen

AH Anchor Health Cooperative

Member Services

A synthetic demo screen — "Anchor Health Cooperative" is a fictional, obviously-fake HMO. No real payer, no PHI. The same resolved-person marts behind Person 360, reframed as the screen a member-services rep works on a call.

Who's on the phone?

Pull up the caller, then work down the screen the way you'd work the call: confirm who they are, reassure them they're covered, answer the money questions, then pull up what they're calling about.

Caller identity

Sanford Fritsch · Member SUB000277-0 · DOB Jun 22, 1923 · M

Subscriber SUB000277 · Group Harbor Technologies

Are they covered?

Coverage at a glance

Member Status

Product

MEDICARE

Network

National Broad PPO

Member-Months

117

Sanford Fritsch is an A -status member on MEDICARE through the National Broad PPO network, with 117 enrolled member-months on record.

What's their money picture?

Here's what we've paid and how their claims land in-network — the talking points a rep gives when a member asks "what did this cost me / was that covered?"

Claims & dollars

Claims on File

1,538

Total Paid

$114,175

Total Billed

$198,648

In-Network Rate

0.0%

What are their plan's benefits?

The "let me pull up your plan's benefits" move — the copays, deductible, out-of-pocket max, and in-vs-out-of-network coinsurance for the caller's plan. Benefits are read at the segment level: the caller's primary product category picks the representative package its members most commonly hold (from benefit_by_segment).

Plan benefits — for the MEDICARE segment

Copays — what the member pays per visit or prescription:

PCP Visit

$10

Specialist

$40

ER Visit

$120

Rx Generic

Rx Brand

$55

Accumulators & coinsurance — the annual limits and the member's share after deductible:

Individual Deductible

$200

Family Deductible

$200

Out-of-Pocket Max

$8,000

In-Network Coins.

20%

Out-of-Network Coins.

47%

On MEDICARE ( Medicare ), the member pays a $10 PCP copay and 20 % in-network coinsurance after a $200 individual deductible, up to a $8,000 out-of-pocket max. Out-of-network coinsurance is 47 %.

Benefits shown are for the caller's segment (product category), using the representative package its members most commonly hold — person_360 carries the primary product category, not a specific product id. Values are realistic-synthetic and vary by segment (Medicaid/Dual near-$0 cost-share, Medicare standard, Commercial richer/varied); the norms are documented in business-rules/benefit/benefit_cost_sharing.md. Plan-tier variation (bronze/silver/gold) within a segment is a later enrichment.

What are they calling about?

Their most recent activity — newest first. This is the "let me pull up your recent visits and claims" move: recent encounters and claims, so the rep can say "I see your visit on the 14th / your claim for X."

Recent activity — last 12 events, newest first

No Results

Recent activity shows the 12 newest events for the selected member from person_events. Need the full history or the whole-population view? The analyst screen — Person 360 — carries the full timeline and the cohort comparison. This screen is deliberately one-member-at-a-time: it's the rep's call view, not a report.