Insurance Reception

استقبال التأمين — Service Blueprint

Journey Stages

Customer Needs

Issues Found

High Severity

Service Blueprint Map

Stage	Patient Actions	Onstage Actions	Backstage Actions	Support Processes
1 Insurance Verification	Provide insurance card and ID	Verify coverage, check policy status, create class if needed	Process insurance approval, verify contract terms	Insurance PortalHISContract Database
2 Approval Processing	Wait in comfort area (not at desk)	Process approval, communicate status updates to patient, handle rejections	Coordinate with insurance company, prepare justification documents	Insurance SystemFax/EmailApproval Workflow
3 Resolution	Receive approval confirmation or alternative options	Inform patient of approval, guide to next step, or explain alternative payment options	Update patient file, log approval/rejection, generate reports	Billing SystemPatient FileAnalytics

Patient Actions

Provide insurance card and ID

Onstage Actions

Verify coverage, check policy status, create class if needed

Backstage Actions

Process insurance approval, verify contract terms

Support Processes

Insurance Portal, HIS, Contract Database

Customer Needs

Quick insurance processing

Clear communication about status

No unnecessary waiting

Transparent process

First-time approval

Minimal back-and-forth

Staff Behavior Standards

Proactive status updates

Clear communication

Empathy during delays

Efficient processing

AIDET® Communication Script

Scenario

"Patient needs insurance approval processing"

Acknowledge

Hello, Mr./Ms. [Patient Name]. I see you need insurance processing. Let me take care of that for you.

Introduce

I am [Your Name], the insurance coordinator. I will handle your approval process from start to finish.

Duration

The approval process typically takes about 10-15 minutes. I will keep you updated throughout.

Explanation

Please have a seat in our comfortable waiting area. I will process your insurance approval and come to you personally when it is ready. You do not need to wait at the desk or come back to check — I will find you.

Thank You

Thank you for your patience. Your insurance has been approved, and you are all set to proceed to your appointment.

Waste & Issues Identified

highMotion waste: patient going back and forth to insurance

highPatient forgotten during insurance completion process

highHigh rejection rate

highLow first-time approval rate

Constraints

Policy not available on contract

Insufficient staff coverage

No clear process for follow-up visit limits

Lab and Rad orders require physician reception coordination

Recommendations

Ask patient to wait until policy and class creation is complete

Receptionist to actively follow insurance status

Receipt goes to waiting area to call patient (not patient going back and forth)

Solve follow-up visit limit issues

Address staffing gaps

Reduce rejection rate through better justification

Coordinate Lab & Rad orders with physician reception