AccountId: 011433970860
ContactId: 101085ec-a177-4541-9aea-9c75c09d58f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 591739 ms
Total Talk Time (AGENT): 195060 ms
Total Talk Time (CUSTOMER): 246961 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/101085ec-a177-4541-9aea-9c75c09d58f6_20250124T14:10_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. My name is [PII]. I'm calling on a recorded line for quality training purpose for doctor's office. I need to obtain medical benefits and eligibility for a patient.
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with benefits and eligibility. What is a good callback number?
[CUSTOMER][NEUTRAL] Yes, um, just a moment. Um, my callback number is [PII] and [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, the policy number, uh sorry, the policy number for the patient is
[CUSTOMER][NEUTRAL] 01852130 M as in Mary, L as in
[CUSTOMER][NEUTRAL] Lima 8.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Now for eligibility, [PII], her policy is active.
[AGENT][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] And this is
[CUSTOMER][NEUTRAL] Oh, sorry, uh.
[CUSTOMER][NEUTRAL] Uh, could you please, uh, repeat again the effective date because your voice is not audible to me, so kindly, please.
[AGENT][NEUTRAL] I, I'm so sorry. Yes, sir. I can repeat that. The eligibility, the effective date is [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] Yes, OK. May I know is there any termination date for this policy?
[AGENT][NEUTRAL] No termination date on file.
[CUSTOMER][NEUTRAL] OK. Thank you for that. Um, may I know whether the policy runs on a plan year or a calendar year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Yes. Are you secondary for Medicare?
[AGENT][NEUTRAL] No, we're secondary for major medical.
[AGENT][NEUTRAL] So we are secondary to United Healthcare.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Just a moment. Uh.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for that. Uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. Your secondary for the United Healthcare site.
[CUSTOMER][NEUTRAL] Yeah, what is the specific plan name?
[AGENT][NEUTRAL] Medlink, that's M E D L I N K.
[AGENT][NEUTRAL] Gap, GAP, so it's Medlink Gap.
[CUSTOMER][NEUTRAL] Min gap. Uh, one moment. May I know it is a supplement plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yes. May I know whether it is a standard supplement plan or a um non-standard supplement plan?
[AGENT][NEUTRAL] Can you repeat that question?
[CUSTOMER][NEUTRAL] So whether it is a supplement plan or a non-supplement plan.
[AGENT][NEUTRAL] It is a secondary supplemental plan.
[CUSTOMER][POSITIVE] OK. Thank you for that.
[CUSTOMER][NEUTRAL] So, is there any group number for billing purpose?
[AGENT][NEUTRAL] Yes, sir. That, that group number is 24,050.
[CUSTOMER][NEUTRAL] 24,050, right?
[AGENT][POSITIVE] Yes, sir. That is correct.
[CUSTOMER][POSITIVE] Yes, yes. Thank you for that. Uh, so, um,
[CUSTOMER][NEUTRAL] May I know what type of supplement plan it is, whether it is a standard supplement plan or a non-standard supplement plan?
[AGENT][NEUTRAL] It's just a secondary gap policy.
[CUSTOMER][NEUTRAL] It's OK. Um, I I can see in my end that uh in the previous case, the policy is a non-standard supplement plan and it is a Medicaid type. So could you please, um, double-check again for me?
[AGENT][NEUTRAL] Uh, can you ask that question again? Because I'm not understanding the question. I apologize.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Uh, so, as I can see, in uh, in the previous case for this patient, it is a non, sorry, non-standard supplement plan. So could you please, uh, recheck again for this?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Now we are secondary to the major medical.
[AGENT][NEUTRAL] And I'm finding out if this is standard or non-standard. Bear with me one moment please.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for that.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 174.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And what do you mean by non-standard?
[CUSTOMER][NEUTRAL] So, it is a supplement plan. So, um,
[CUSTOMER][NEUTRAL] It will cover this, uh, it is.
[CUSTOMER][NEUTRAL] Uh, so, one moment.
[CUSTOMER][NEUTRAL] So there is some specific plan names for the standard plans and whether it is a supplement plan A, B, C, R. And when it comes to the non-supplement plan, it doesn't have any plan name. But
[CUSTOMER][NEUTRAL] It, um, the plan which has no name which should be the non supplement plan.
[CUSTOMER][NEUTRAL] So, uh, did you find it or shall I?
[AGENT][NEUTRAL] So you're talking.
[AGENT][NEUTRAL] OK, so you're talking about like maybe a Medicare supplemental ABC or?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, yes, yes, like that.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Whether it is a standard supplement plan or nonsense supplement plan.
[AGENT][NEUTRAL] So, we do not process with Medicare. We are secondary to the major medical coverage.
[AGENT][NEUTRAL] And that is United Healthcare. So we are secondary. It's like it's secondary supplemental.
[AGENT][NEUTRAL] So it would be standard based on their primary insurance coverage.
[CUSTOMER][NEUTRAL] OK. Could you please repeat me, um, could you please repeat the plan name again for me? It is in Medicare.
[AGENT][NEUTRAL] Medlink, it's M E D L I N K.
[CUSTOMER][NEUTRAL] Medley
[AGENT][NEUTRAL] Meddling gap.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you for that. Did you cover, uh, will you cover the Part B to bank coinsurance?
[AGENT][NEUTRAL] Deductible copay, and insurance of the major medical.
[AGENT][NEUTRAL] Provider.
[CUSTOMER][NEUTRAL] So the coverage of the
[CUSTOMER][NEGATIVE] I didn't understand what you have said.
[AGENT][NEUTRAL] Covers the deductible, co-pay, and co-insurance of the major medical.
[CUSTOMER][NEUTRAL] OK. So you'll be off everything, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] You will pay off the everything that has remained by the primary insurance, right?
[AGENT][NEUTRAL] So we would cover what according to the policy guidelines, the deductible, co-pay and co-insurance for the covered services.
[CUSTOMER][NEUTRAL] OK, thank you for that. Will you follow the Medicare guidelines for providers that
[AGENT][NEUTRAL] We do not, not Medicare, it has to be the major medical.
[CUSTOMER][NEUTRAL] OK, so you don't follow the medical.
[AGENT][NEUTRAL] Do we do cover, we would cover the major medical guidelines, not Medicare.
[CUSTOMER][POSITIVE] OK, thank you for support.
[CUSTOMER][POSITIVE] OK. Thank you for that.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][POSITIVE] OK, thank you for that. Um, can my provider can be buy and build this?
[AGENT][NEGATIVE] For the medication, there's no coverage on this policy for medication. If they could have coverage for the administration, but not for the medication.
[CUSTOMER][NEUTRAL] OK. Thank you for providing this information. Could you please spell out your name and provide me the call reference number for this call today?
[AGENT][NEUTRAL] Mhm. Uh my name is [PII].
[AGENT][POSITIVE] And the reference number would be my name and today's date. And it's been a pleasure to assist you with that eligibility policy or anything else I can help you with?
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] No, sir. The information that uh what I have needed has been.
[CUSTOMER][POSITIVE] Uh, but thank you for providing this information. Have a nice day. Thank you. Bye-bye.
[AGENT][POSITIVE] I hope you have a wonderful day as well, [PII], and thank you for calling APL and happy Friday.
[CUSTOMER][POSITIVE] Happy Friday