AccountId: 011433970860
ContactId: 0860d5b1-d642-4c1e-bc44-c99bdd0e60f2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1047650 ms
Total Talk Time (AGENT): 220166 ms
Total Talk Time (CUSTOMER): 321497 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/0860d5b1-d642-4c1e-bc44-c99bdd0e60f2_20250415T20:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, I, good afternoon. My name is [PII] and I'm calling from provider's office to check eligibility and benefits.
[AGENT][NEUTRAL] OK, [PII], I can help you with the eligibility and benefits today. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, that is 02486903, M as in Mary, L as in Lima, number 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. And the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line, no extension.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Is this policy active?
[AGENT][NEUTRAL] Yes, ma'am. So it looks like the policy is active. The effective date is [PII].
[AGENT][NEUTRAL] And then you wanted to check benefits?
[CUSTOMER][NEUTRAL] OK, termination date is now.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what will the plan type plan name?
[AGENT][NEUTRAL] Yes, it looks like this is a meddling plan.
[CUSTOMER][NEUTRAL] Uh, you can spell that?
[AGENT][NEUTRAL] Yes, it is MED.
[AGENT][NEUTRAL] L
[AGENT][NEUTRAL] I N K.
[CUSTOMER][NEUTRAL] And uh it's uh like a PPO, POS, what type of plan it is?
[AGENT][NEUTRAL] Uh, plan one.
[CUSTOMER][NEUTRAL] And one, not a PPO, POS EPO or HMO?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] So it says Medin SFX.
[CUSTOMER][NEUTRAL] Madeing FF X.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I'm asking you like that, it's a HMO PPO. What type of a plan?
[AGENT][NEUTRAL] Let's see, just one moment.
[AGENT][NEUTRAL] Uh, this is a supplemental meddling policy.
[CUSTOMER][NEUTRAL] It's a supplement plan.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's secondary to the major medical.
[CUSTOMER][NEUTRAL] Uh, which plan?
[CUSTOMER][NEUTRAL] Which type of a plan it is like uh plan G, plan F, what type of plan, supplement?
[AGENT][NEUTRAL] It's just secondary to the major medical plan.
[CUSTOMER][NEUTRAL] Yeah, I know that. You said it's a supplement plan. So, which plan?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, it's a plan G, plan F, and.
[AGENT][NEUTRAL] It's a supplemental meddling plan, plan one.
[CUSTOMER][NEUTRAL] So it, uh, is there any specific benefit like co-pay coinsurance deductible or it will cover 100%?
[AGENT][NEUTRAL] OK, so you're wanting to check benefits as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so you're needing the out you want the outpatient amount?
[CUSTOMER][NEUTRAL] Yes, home infusion for outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you need the CPT code?
[AGENT][NEUTRAL] No, I do not. Um, so the outpatient benefit max per calendar year is $1000.
[AGENT][NEUTRAL] And this is not a guarantee payment, just a verification of coverage.
[AGENT][NEUTRAL] So that is the outpatient amount. Are you looking for another benefit?
[CUSTOMER][NEUTRAL] Yeah, what is the deductible out of pocket co-pay coinsurance?
[AGENT][NEUTRAL] There is no we do not cover copays.
[CUSTOMER][NEUTRAL] For insurance?
[AGENT][NEUTRAL] So there is no co-pay for any services. This is just a benefit.
[CUSTOMER][NEUTRAL] OK, so there's no co-pay, no coinsurance, no deductible plan, no out of pocket, and up 100%.
[AGENT][NEUTRAL] We do not cover 100%.
[CUSTOMER][NEUTRAL] You are secondary to the medi uh secondary insurance to this plan.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So we cover 100% or if there is any specific responsibility of a patient?
[AGENT][NEUTRAL] This policy covers the major medical, which is co-pay co-insurance and deductible amounts up to the policy benefit max.
[CUSTOMER][NEUTRAL] So what is that amount? OK? You said there is no copay. What is the co-insurance deductible or out of pocket amount?
[AGENT][NEUTRAL] Well, we do not determine patient's responsibility. I only can give you the, the patient's benefits. So the outpatient benefit max per calendar year on this patient's policy is $1000.
[CUSTOMER][NEUTRAL] And what about the accumulations?
[AGENT][NEUTRAL] Sorry, what was that?
[CUSTOMER][NEUTRAL] What about their accumulations?
[AGENT][NEUTRAL] Sorry, can you repeat that?
[CUSTOMER][NEUTRAL] What will be the accumulation? You said $1000 is out of pocket amount. What about the accumulations? And how much it will be used?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I am checking. Just one moment, OK?
[AGENT][NEGATIVE] So it looks like no benefit has been used as of this year.
[CUSTOMER][NEUTRAL] That is uh
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] The amount is for?
[AGENT][NEUTRAL] The amount
[CUSTOMER][NEUTRAL] That is allowed amount?
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and uh I'm checking the allowed amount for you, OK? Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, I'm here. Sorry.
[CUSTOMER][NEUTRAL] The supplement plan will always cover 100%.
[AGENT][NEGATIVE] No, no, this will not cover 100%. It's just a verification of coverage. It's not a guarantee of payment.
[AGENT][NEGATIVE] And for this policy, no benefit has been used as of this year.
[CUSTOMER][NEUTRAL] So what is the benefit?
[AGENT][NEUTRAL] So the outpatient benefit max per calendar year is $1000.
[AGENT][NEUTRAL] And as of right now,
[CUSTOMER][NEUTRAL] Out of pocket is still
[AGENT][NEUTRAL] Sorry, go ahead.
[CUSTOMER][NEUTRAL] The amount of 1000, it is for individual out of pocket?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] No, that is maximum outpatient benefit.
[CUSTOMER][NEUTRAL] means the allowed amount is there, that is 1000.
[AGENT][NEUTRAL] Yes, it's per calendar year.
[CUSTOMER][NEUTRAL] That it is for what it's an individual deductible or out of pocket.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So the outpatient benefit max per calendar year is $1000.
[AGENT][NEUTRAL] Did you have another question about that outpatient benefit?
[CUSTOMER][NEUTRAL] Yeah, can the physician buy and bill, do you have any specialty pharmacy name and their contact number?
[AGENT][NEUTRAL] Do you, do you need my reference number?
[CUSTOMER][NEUTRAL] I'm asking you about the specialty pharmacy name.
[AGENT][NEUTRAL] OK, let me just put you on a brief hold really quick. I'm going to transfer you over to a colleague, OK?
[AGENT][POSITIVE] And she'll further assist you. I'm, I will transfer you over to one of my colleagues and she can further assist you, OK?
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Hi. OK. Um.
[CUSTOMER][NEUTRAL] Hey [PII]
[CUSTOMER][NEUTRAL] And you can stay on the phone if you want to.
[AGENT][NEUTRAL] OK, I'll just click join and then mute. Do you want do you want me to speak first and just let her know?
[CUSTOMER][NEUTRAL] No, give me the policy number.
[AGENT][NEUTRAL] OK. It is 3, 2486903.
[CUSTOMER][NEUTRAL] 2,486,690
[AGENT][NEUTRAL] 24869003.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good afternoon. My name is [PII] and I'm calling from provider's office to check patient eligibility and benefits.
[CUSTOMER][NEUTRAL] OK, so did she give you the outpatient benefit of $1000 per calendar year?
[CUSTOMER][NEUTRAL] Yeah, that is for deductible or that is for out of pocket.
[CUSTOMER][NEUTRAL] That's not the out of pocket, that's the benefit under the patient's policy.
[CUSTOMER][NEUTRAL] So it's a supplemental plan or what is that?
[CUSTOMER][NEUTRAL] OK, so this is a supplemental gap policy. It's secondary to the major medical plan. This policy is sent with covered charges under the deductible, co-insurance, and co-pay amounts.
[CUSTOMER][NEUTRAL] So, it will cover 100% with no patient responsibility.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It will cover 100% with no patient responsibility, like no co-pay, no co-insurance, no deductible, and no out of pocket.
[CUSTOMER][NEUTRAL] It covers up to $1000 per calendar year of covered charges.
[CUSTOMER][NEUTRAL] Of any amount applied towards the major medical deductibles, co-insurance, and their co-pay amount.
[CUSTOMER][NEUTRAL] The cover charges is $1000.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] The cover charges is 1000, correct?
[CUSTOMER][NEUTRAL] That's the maximum outpatient benefit.
[CUSTOMER][NEUTRAL] OK, do you have any specific benefit?
[CUSTOMER][NEUTRAL] Do you have any specific benefit like co-pay for insurance deductible or out of pocket amount?
[CUSTOMER][NEUTRAL] OK, this is a secondary supplemental policy. There is no co-pay, deductible, or co-insurance under the APL policy.
[CUSTOMER][NEUTRAL] OK, I got it. And can the physician buy and bill?
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Do you have any specialty pharmacy name and their contact number?
[CUSTOMER][NEGATIVE] OK, could you slow down just a bit because I can't understand you, you're talking too fast.
[CUSTOMER][NEUTRAL] I'm asking you that, do you have any other insurance or you have uh secondary insurance to this plan?
[CUSTOMER][NEUTRAL] OK. Are you asking if the patient has other insurance?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, that's a question for the policy holder. We can just speak to the policy that they have with American Public Life.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So it's a supplemental plan like supplement, just a moment. It's supplemental plan.
[CUSTOMER][NEUTRAL] Supplemental gap policy. Correct. It's a no co-pay, no co-insurance, no deductible, not the pocket.
[CUSTOMER][NEUTRAL] OK. Help me with your name call reference number.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Help me with your name and call reference number. You'll use my name in today's date as reference for today's call. It's [PII]. First initial of my last name is [PII]. And did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] No, thank you.
[CUSTOMER][POSITIVE] You're welcome thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too, bye.