AccountId: 011433970860
ContactId: 126ab967-8721-4d73-bfa8-171caf220151
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302190 ms
Total Talk Time (AGENT): 132209 ms
Total Talk Time (CUSTOMER): 105207 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/126ab967-8721-4d73-bfa8-171caf220151_20250617T16:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] calling from Genentech Access Solutions at the request of Doctor [PII] on behalf of the patient. This call may be monitored and or recorded for quality and training purposes.
[CUSTOMER][NEUTRAL] And I apologize, did you say your name was [PII]?
[AGENT][NEUTRAL] Um, it's [PII]. Um it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Perfect. Ay, I was calling today for benefits information for an eye injection done in a specialist office. It'll be covered under their medical benefits.
[AGENT][POSITIVE] Um, yes, sir. I can assist you with benefits. Um, could I please get your name one more time?
[CUSTOMER][NEUTRAL] It's [PII] spelled [PII], last initial [PII]
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, I need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] OK. Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 02616250
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], uh, [PII].
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active, and you said this is for services provided in office.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, under this policy, the co-pay for the office visit is not covered, but any other charges that goes towards the co-insurance and the deductible after the co-pay process is the claim, we cover up to $500 per day.
[CUSTOMER][NEUTRAL] OK. What kind of policy is this?
[AGENT][NEUTRAL] This is Secondary gap Insurance.
[CUSTOMER][NEUTRAL] OK, so it's not, uh, so is that like a commercial policy or is it like Medicaid?
[AGENT][NEUTRAL] It's a commercial policy. We work with the um the primary insurance, which is private insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I'm trying to figure out how exactly this.
[CUSTOMER][NEUTRAL] Cover up to $500. So it's not like they have to meet $500 you cover up to $500. And then after that, they, you cover nothing.
[AGENT][NEUTRAL] Right, it's patient responsibility. Um, yes, sir. What normally happens is the provider will file the claim first with the primary insurance and the charges that go towards the co-insurance and deductible, the provider will bill us um along with the $1500 claim form. Along with that claim form, they'll send the EOB from the primary insurance and we'll cover up to $500 for that day. And um
[AGENT][NEUTRAL] After that, if there's a remaining balance, again, it'll be patient responsibility.
[CUSTOMER][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] What is, so if it's a commercial plan, does it have a plan type? Is it like a PPO HMO?
[AGENT][NEUTRAL] Um, no, sir. It's Gap Insurance.
[AGENT][NEUTRAL] We work with PTOs and HMOs.
[CUSTOMER][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] Um, and then as far as prior authorization, is that just left to the primary insurance?
[AGENT][NEUTRAL] Yes, sir. We go by the primary carrier, so, yes, up to the primary insurance. Cause if the primary carrier doesn't cover a charge, then we don't cover it either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, all right.
[CUSTOMER][NEUTRAL] OK, I think that's all the information I needed. um, did you have a reference number for the call?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] Last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, ABM 6-172025. OK. Uh, no, that should do it. I appreciate your help with benefits today.
[AGENT][POSITIVE] Yeah, thank you, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Alright thank you bye.
[AGENT][POSITIVE] Thank you.