AccountId: 011433970860
ContactId: 06835c67-14f7-426d-96b8-51903cf3b4b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231440 ms
Total Talk Time (AGENT): 111541 ms
Total Talk Time (CUSTOMER): 56509 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/06835c67-14f7-426d-96b8-51903cf3b4b5_20250415T13:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Yes, I'm calling from Palmetto podiatry Group, and I'm calling to get benefits for a patient.
[AGENT][POSITIVE] OK, I can assist you with benefits. Give me one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] May I have your name please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] [PII], thank you, [PII] and your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you so much, Miss [PII], and what is the policy number please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 1275042
[AGENT][NEUTRAL] OK, I have that as 1275042.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, it is.
[CUSTOMER][NEUTRAL] [PII], birthday [PII].
[AGENT][NEUTRAL] OK, thank you very much and you're calling for benefits would that be for outpatient?
[AGENT][NEUTRAL] For her.
[CUSTOMER][NEUTRAL] Um, it's for custom orthotics place of service home.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Is it I'm sorry, DME?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if you have the DME benefit one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Of course, thank you.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guarantee payment. The outpatient max for the calendar year for covered services is $2000 and that's the calendar year policy. Um, she does have a writer to cover DME for covered DMA. I can check to see if anything that's been accumulated towards the $2000 for this year.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, you're welcome. One moment.
[AGENT][NEUTRAL] She has not accumulated anything towards the $2000 for the calendar year.
[CUSTOMER][NEUTRAL] OK. Is that kind of like a deductible?
[AGENT][NEUTRAL] Uh, no, what we do is we help with her major medical deductible, co-pay and co-insurance based on coverage. She does not have a deductible or out of pocket to meet with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if her primary carrier applies it toward her deductible, then how does that work with you guys?
[AGENT][NEUTRAL] If it is applied to her deductible, then what you do is you'll send a claim in for us for uh review and processing. If it's a covered um benefit, of course we'll cover up to what was applied to the deductible by the major medical.
[CUSTOMER][NEUTRAL] OK, and is authorization required?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK. All right, thank you. And may I get a reference number?
[AGENT][NEUTRAL] Uh, you're welcome. We do not use the reference numbers, [PII]. Please use my name [PII] last initials [PII] and today's date. Would you need any information as far as claim submission, mailing address, fax number?
[CUSTOMER][NEUTRAL] Yes, what is the claim's address?
[AGENT][NEUTRAL] OK, it is APL claims [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.