AccountId: 011433970860
ContactId: 17e590f6-2702-41ae-8a23-6aba637fecf8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456959 ms
Total Talk Time (AGENT): 164553 ms
Total Talk Time (CUSTOMER): 209346 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/17e590f6-2702-41ae-8a23-6aba637fecf8_20250425T19:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. It's spelled as [PII], and this call is regarding members validity and benefits. Could you please spell your first name?
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] My name is [PII], that's initial [PII].
[CUSTOMER][NEUTRAL] Now as it can.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] And Ms. [PII], I can assist you with eligibility and benefits. I just need a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the name of the facility you're calling from, Ms?
[CUSTOMER][NEUTRAL] That is sleep remedies LLC.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, that is 01986722.
[AGENT][NEUTRAL] Mm. Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Let me check and see if I have a different policy. This one is terminated.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yeah, I did find a new policy. Let me know when you're ready for the new number.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] The new policy number is 02.
[AGENT][NEUTRAL] 46
[AGENT][NEUTRAL] 2788.
[CUSTOMER][NEUTRAL] 88.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, let me confirm the policy number. That is 02462788.
[AGENT][NEUTRAL] Correct, yes. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is active. This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK. Is this a supplement plan?
[AGENT][NEUTRAL] It's a secondary supplemental to the major medical, to any major medical.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. One minute, please. And let me pull up my new note.
[CUSTOMER][NEUTRAL] Because it is supplement insurance, that's why.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] What is, uh, does the, is there any specific alphabet for this patient, uh, for the plan like G and H.
[AGENT][NEUTRAL] No, it's not a Medicare. It's, it's supplemental to the major medical, to any major medical.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One
[CUSTOMER][POSITIVE] OK. It's a medical supplement. That's correct.
[AGENT][NEUTRAL] No, no. No, it's not a medical supplemental at all. No.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] It's a secondary supplemental to the major medical. It's a secondary policy to the major medical.
[CUSTOMER][NEUTRAL] It's a major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh does this plan, uh, does this policy cover the Part B deductible if Medicare is primary?
[CUSTOMER][NEUTRAL] This.
[AGENT][NEUTRAL] We follow major medical.
[AGENT][NEUTRAL] Um, what type of service is being rendered?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] It's for DME.
[AGENT][NEUTRAL] DME. OK, let me check and see if it's something that is covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is not a guarantee of payment the verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and let's see. So it looks like we do cover DME. Now we only cover the equipment, we do not cover any disposable supply. Um, this is subject to the outpatient maximum of 4000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And we help with the deductibles, co-payment, and co-insurance from the major medical, which is CCBS.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so is there any deductible and out of pocket amount?
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] No. OK. I
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] This policy follows uh major medical.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Plan. That's correct?
[AGENT][POSITIVE] Correct, that is correct.
[CUSTOMER][NEUTRAL] OK. Uh, one moment, please. One minute, please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, how much it will pay if, uh, uh, how much it will pay if, uh, primary allowed?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Uh, how much it will be?
[CUSTOMER][NEUTRAL] For the uh if if primary allowed.
[AGENT][NEUTRAL] OK, I can only give you the benefits of the policy. I cannot tell you specifically how much it's gonna pay. Um, again, the benefit of the policy for outpatient service, including DME for equipment, not for, um, disposable supply is up to $4000 for any outpatient services during the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. And this plan does not cover DMA benefits, that's correct?
[AGENT][NEUTRAL] It does cover DME. It just doesn't cover disposable supplies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And help me with the call reference number for this patient.
[AGENT][NEUTRAL] OK, we don't have reference numbers you can use my name in today state if you will.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. That's all for today. Thank you for your help. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Have a good day. Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah