AccountId: 011433970860
ContactId: 18d8d497-da68-417d-94b2-e8390afdd5de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 525609 ms
Total Talk Time (AGENT): 242201 ms
Total Talk Time (CUSTOMER): 127291 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/18d8d497-da68-417d-94b2-e8390afdd5de_20250610T20:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL.
[AGENT][NEUTRAL] I can help you.
[CUSTOMER][NEUTRAL] Yes, hi, uh, my name is [PII]. I'm calling from Palmet Infusion Services. How are you doing this afternoon?
[AGENT][NEUTRAL] I'm doing fine. Did you say your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, yes, ma'am. I. Hi, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, ma'am. I was just trying to get some information on this policy. Um, we are actually a facility that provides home infusion therapy, um, and I was trying to see this, is this like a medical policy? Does it have benefits or is it like an accidental policy? Because I was listening to the automated service earlier, so I was just trying to get some information on it.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so are you needing to verify eligibility and also benefit information for a member? Is that essentially what you're needing? OK, yes, I, I can help you with that. And first off, what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it's gonna be [PII].
[AGENT][NEUTRAL] Thank you. And what is that member's policy number, please?
[CUSTOMER][NEUTRAL] 02592443
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Certainly, you're welcome. One moment.
[AGENT][NEUTRAL] Bear with me, [PII]. I had to reopen a couple of my screens, so just one moment, please.
[CUSTOMER][POSITIVE] Not a problem thank you.
[AGENT][POSITIVE] Thank you. Uh-huh, thank you.
[AGENT][NEUTRAL] And any information that I do provide for you will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, yes, we have it, uh, from her other insurance policies, we have it as a [PII], but the first name is [PII], so I'm not sure how you all have it, but it's [PII], um, and her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so first off, I do show that she is the subscriber on the supplemental policy.
[AGENT][NEUTRAL] And the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you can please bear with me another moment to try to get some policy information pulled up for you for some reason I can't see all of her information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'm sorry, thank you for understanding.
[CUSTOMER][POSITIVE] Not a problem.
[AGENT][POSITIVE] I am so sorry about this.
[CUSTOMER][POSITIVE] No problem. I definitely understand. I feel like even the computers are like it's the end of the day.
[AGENT][NEUTRAL] Some things are just so out of my control, right? But some things are just out of our control, no matter.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No matter what.
[CUSTOMER][POSITIVE] Understandable.
[AGENT][NEUTRAL] OK, alright, finally, so I can provide you some information. So again, this is a supplemental policy to her primary insurance, OK, that helps with her copay, deductibles and co-insurance amounts of coverage services. Now this policy if there's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Infusion therapy can be reviewed under the outpatient benefit. However, it specifically states in her policy infusion therapy in an infusion therapy center or a hospital outpatient facility or a physician's office.
[CUSTOMER][NEUTRAL] So that's the only infusion therapy it covers, is what you're saying?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. So it was infusion therapy and uh can you, can you say it for me again, please?
[AGENT][NEUTRAL] I can. Uh-huh. So, uh, let's see. Let me go back. Infusion therapy and an infusion therapy center.
[AGENT][NEUTRAL] Or a hospital outpatient facility.
[AGENT][NEUTRAL] Or a physician's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or a physician's office.
[AGENT][NEUTRAL] Yes, ma'am. Are the cover places a service for infusion therapy on this policy.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And do you know how much um.
[CUSTOMER][NEUTRAL] They will cover?
[AGENT][NEUTRAL] On this supplemental policy, the outpatient benefit maximum for covered outpatient services per calendar year is $4200 with no deductible.
[AGENT][NEUTRAL] And because it is like.
[CUSTOMER][NEUTRAL] OK, so that's what they would cover automatically.
[AGENT][NEUTRAL] Well, that's the benefit maximum for covered services on this policy per calendar year.
[AGENT][NEUTRAL] Again, I can't guarantee payment, we would have to receive the claim along with the primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then lastly, once we process a claim here at APLCC, we do have a portal that you should be able to check claim status in.
[AGENT][NEUTRAL] And our website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you. Gotcha. Um, and you said that maximum was how much?
[AGENT][NEUTRAL] $4200 per calendar year for covered outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Um, just a question, do you all, um, allow facilities to buy and build under the medical benefit or no?
[AGENT][NEUTRAL] No, no, ma'am.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][POSITIVE] OK. Understandable, understandable.
[AGENT][NEUTRAL] And this follows the primary insurance. Also, anything not covered by primary would not be covered by APO later.
[AGENT][NEUTRAL] Since it helps in those three categories that I explained to you.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Thank you. All right, uh thank you very, very much. Um, could I just get your name and first initial again, um, and a call reference number? I, I didn't catch it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Well, you are certainly welcome.
[AGENT][NEUTRAL] Again, my name
[AGENT][NEUTRAL] Yeah, my name is [PII]. The first initial to my last name is [PII], and my name in today's date would be your call reference number.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you so much, [PII] for explaining this to me. I really appreciate you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you're certainly very welcome. So again, can I help you with anything else, [PII]?
[CUSTOMER][POSITIVE] No, that is all. Thank you.
[AGENT][POSITIVE] OK. Well, you're very welcome and thank you for calling APL. I hope you have a wonderful rest of your day.
[CUSTOMER][NEUTRAL] OK, same to you.
[AGENT][POSITIVE] Uh-huh, thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.