AccountId: 011433970860
ContactId: 11b084b4-595f-44cb-9ac6-e4f9c8a69f47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 480910 ms
Total Talk Time (AGENT): 181042 ms
Total Talk Time (CUSTOMER): 148431 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/11b084b4-595f-44cb-9ac6-e4f9c8a69f47_20250131T13:10_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of the Test fire Together program on a recorded line for training and quality assurance. I'm looking for some benefit information for the patient.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and my last name initial is [PII].
[AGENT][NEUTRAL] Thank you and saving you're needing benefit information, is that correct?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] And my direct callback number is [PII]. No extension is required.
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Uh, the numbers, uh, the member ID number is 01792121.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And what is your patient's name and their date of birth?
[CUSTOMER][POSITIVE] Sure, no problem. Thank you.
[CUSTOMER][NEUTRAL] The member's name is, member's first name is [PII], spelled [PII] and the last name is uh [PII], spelled [PII] The date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So I do show that he is the subscriber on the supplemental policy. The supplemental policy is active, effective [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Looking for this uh specialist office. It's uh outpatient service and specialist office.
[AGENT][NEUTRAL] OK, so under the
[AGENT][NEUTRAL] OK, so on this policy, the office visit is not a covered service. It is not a covered benefit under this policy. He does have an office treatment writer on the policy in which we can review under his outpatient benefits for treatment within the office, his outpatient calendar year benefit max.
[AGENT][NEUTRAL] For covered outpatient services is $5000 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, thank you for the information. And I just like to let you know that actually I'm calling to verify uh in-network benefits for an injection of the.
[AGENT][NEUTRAL] OK, this policy
[AGENT][NEUTRAL] There is no network affiliated with the supplemental policy. It follows his primary insurance. And because this is a supplemental policy to his primary insurance, when the claim is submitted to us for review, we must also receive a copy of his primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then once we have processed our claims, [PII].
[CUSTOMER][NEUTRAL] OK. Uh
[AGENT][NEUTRAL] You may check claim status by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Uh, sure. And, uh, is there a standard plan letter for the patient supplemental plan?
[AGENT][NEUTRAL] There is not because we didn't, we're not a major medical insurance.
[CUSTOMER][NEUTRAL] OK. And uh what's the plan name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] And uh what is the for billing purpose, what is the group name?
[AGENT][NEUTRAL] Oklahoma Allergy and asthma clinic.
[CUSTOMER][POSITIVE] OK, thank you. Just give me one moment.
[CUSTOMER][NEUTRAL] And uh what is the group number for billing purposes?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 236-33.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] Thank you for that information.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And uh and could you please spell out your first name and provide the initial of the last name for the notes please.
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] And my name and today's date will be your call reference number, [PII].
[CUSTOMER][NEUTRAL] Yeah, sure, and I, I still have a few other questions, uh, that is, uh, will this plan cover plan be deductible?
[AGENT][NEUTRAL] We do not pay claims over the phone, [PII]. So again, this policy is a supplement to the primary insurance. We will have to receive the claim along with the primary insurance company's detailed explanation of benefits for review.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, so just want to know, does this plan cover the Plan B deductible? it's a yes.
[AGENT][NEUTRAL] I just answered your question. Yes, sir, I just answered your question.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh and does the, and does this plan cover 100% of the 20% remaining from Medicare?
[AGENT][NEUTRAL] I, this is not a Medicare supplement, sir.
[AGENT][NEUTRAL] [PII], this is a primary insurance to their major medical insurance, not Medicare.
[CUSTOMER][NEUTRAL] So what is the plan type? Is it a PPO, POS or HMO?
[AGENT][NEUTRAL] No, sir. Neither. I've already given you this information, [PII] and I don't know how else I can say it. This is a supplemental Medlink policy only.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] OK, sure, thank you, just give me a moment please.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Uh, thank you, [PII]. Thank you for waiting patiently. Uh, I think I've got the information. Uh, uh, the reference, what is it, can you help me with the reference number, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir. I told you that it would be my name and today's date.
[CUSTOMER][POSITIVE] Uh thank you, [PII]. Thank you so much for your help today. Have a great day. Bye.
[AGENT][POSITIVE] Yes, sir, you too, and thank you again for calling [PII], I mean [PII], have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you, bye bye.