There is no single medical profile that guarantees eligibility. We evaluate a combination of risk factors. The process is intentionally broad to account for diverse needs, but that also creates gray areas, and patient expectations aren’t always aligned with the criteria.
Common issues include:
— Patients who downplay symptoms because they don’t want to be a burden
— Patients who once qualified, but whose condition has improved
— Patients who rely on family for transport but are suddenly without help
In some cases, we’re required to ask about weight, ability to walk unaided, or end-of-life preferences such as Do Not Resuscitate status. These are deeply personal topics. We know that every question must be phrased with care and every answer evaluated with empathy.
Our agents are not medical professionals, yet they’re asked to make real-time judgments that affect someone’s ability to access care. The agents follow strict guidelines, but each call still requires critical thinking and emotional intelligence.