AccountId: 011433970860
ContactId: 0895c038-3eda-47f8-beaf-dfb337073c67
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438019 ms
Total Talk Time (AGENT): 120301 ms
Total Talk Time (CUSTOMER): 204378 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/0895c038-3eda-47f8-beaf-dfb337073c67_20250428T18:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling from Botox one. I need to inform you that this call is being recorded for quality and training purposes. I'm calling at the request of Doctor [PII] to obtain benefits for the physician administer medication Botox. Uh, what information do you need from me before we begin?
[AGENT][NEUTRAL] OK, do you have the policy number on you?
[CUSTOMER][NEUTRAL] Yes, of course, um, before that, please can you repeat your name and the initial of your last name?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII], last initial [PII]
[CUSTOMER][NEUTRAL] OK, got it. Thank you. Uh yes, the policy ID is 02141802.
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] [PII], option 1.
[AGENT][NEUTRAL] OK, perfect. And the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, it's [PII].
[AGENT][NEUTRAL] OK. And is this for an office visit?
[CUSTOMER][NEUTRAL] Uh, and, um, well, no, we won't build office visits, but I'm, um, I would like to start with eligibility information if you don't mind, and after that, then its for some quotes.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, of course. OK, so the policy is currently active.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what's the plan name?
[AGENT][NEUTRAL] The plan name is Medlink.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's [PII]
[CUSTOMER][NEUTRAL] Mhm. OK. And uh what's, um, what's the plan type?
[AGENT][NEUTRAL] The plan type is 50,005,000.
[CUSTOMER][NEUTRAL] This is a supplemental plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the product ID is Medlink 6, so it's 6 at the end.
[CUSTOMER][NEUTRAL] We 6. OK. And um uh this is a supplemental uh policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, this is a secondary policy to their primary insurance.
[CUSTOMER][NEUTRAL] Second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, uh, and there's no, uh, there's no PPO or, um, HMO type. It's a supplement, uh.
[CUSTOMER][NEUTRAL] Supplement policy, OK.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] Ah, thank you. This plan runs on calendar year basis?
[AGENT][NEUTRAL] Let me double check the benefits really quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it's per calendar year.
[CUSTOMER][NEUTRAL] OK, thank you. Uh please can you check the network status of these providers?
[AGENT][NEUTRAL] So there was, there is no certain network for this policy.
[CUSTOMER][NEUTRAL] Oh, OK. Thank you. So no referral required, neither, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. Uh, would you mind checking to verify if uh the J code, J as in Juliet, 0585 is covered under major medical benefits, uh, uh, do you need the diagnosis code?
[AGENT][NEUTRAL] So we cannot see what their major medical is covered.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. So you, you follow the, the uh primary guidance.
[AGENT][NEUTRAL] So this is a secondary policy, so we can't see what their primary uh paid.
[CUSTOMER][NEUTRAL] Oh, OK, if, if the primary, uh, um, denies you deny. If the primary covers, you cover this, uh. OK, great. Thank you. And um
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] As a supplemental there's no patient responsibility, correct?
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] So, we do not determine patients responsibility.
[CUSTOMER][NEUTRAL] Uh-huh, thank you. And in, in it's erization required?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, no pre-authorization required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do being secondary.
[AGENT][NEUTRAL] Yes, we are secondary.
[CUSTOMER][NEUTRAL] OK, got it. OK, [PII], um, uh, for this, um, uh, for this plan, the provider can buy and build and can use a specialty pharmacy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Say that again? I'm sorry.
[CUSTOMER][NEUTRAL] The provider can uh buy and bill, and uh the provider can use a specialty pharmacy.
[AGENT][NEUTRAL] Uh, let me double check in their benefits, just a second if they have.
[AGENT][NEUTRAL] A certain pharmacy. Mhm.
[CUSTOMER][NEUTRAL] Thank you. According to my file, in the past we were allowed to use a Credo and Walgreens.
[AGENT][NEUTRAL] OK, yes, if it's a meddling policy, that would still be correct. Mhm.
[CUSTOMER][NEUTRAL] OK, great, thank you. Uh thank you. uh, now I have all the information I need for this uh patient here, can I get uh the reference number for this call?
[AGENT][NEUTRAL] Yes, of course. It's my first name, [PII]
[AGENT][NEUTRAL] Last initial [PII] and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2 days, got it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you so much for your help and have a wonderful, wonderful evening.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Yes, we appreciate you calling APL you too.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye.