AccountId: 011433970860
ContactId: 1991590c-d035-47db-a8a9-506ecc5996fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250929 ms
Total Talk Time (AGENT): 97901 ms
Total Talk Time (CUSTOMER): 107958 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/1991590c-d035-47db-a8a9-506ecc5996fa_20250122T15:08_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, my name is, hello, my name is [PII]. Last name first initial [PII], and I'm calling for provider office to verify the patient eligibility and benefits. Please note that this call is being recorded and monitored for quality and training purpose.
[AGENT][NEUTRAL] Sure, I, I could assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] The callback number is [PII] with the extension of [PII].
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] It's 01852130 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you, [PII]. What is the member's name and date of birth?
[CUSTOMER][NEUTRAL] The member's name is
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits to eligibility for what place of service?
[CUSTOMER][NEUTRAL] Uh sorry, could you please repeat that again?
[AGENT][NEUTRAL] You're calling to verify benefits and eligibility for what place of service, inpatient, outpatient, office visit, diagnostic testing.
[CUSTOMER][NEUTRAL] Uh, it's
[CUSTOMER][NEUTRAL] Yeah, it's for the outpatient.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the member has outpatient benefits?
[CUSTOMER][NEUTRAL] OK. Uh, and, uh, could you please check whether the policy runs on a plan year or a calendar year?
[AGENT][NEUTRAL] Plan your January to a calendar year January to December. The member has outpatient benefits of $7000.
[AGENT][NEUTRAL] Her calendar year and this is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and uh also could you please check if there is any group number for billing purpose?
[AGENT][NEUTRAL] There is a group number. The group number is 24,050. That's 24,050. Would you like the group name as well?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] No, I just wanted the group number. Thank you for asking and uh
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah. Could you please uh check what's the specific plan name? Is it Plan A or Plan G?
[AGENT][NEUTRAL] This is the gap insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's a non-standard supplement plan, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, and uh is this secondary to Medicare?
[AGENT][NEUTRAL] This is secondary to whatever the member has. I'm not sure what's the primary insurance, but this is gonna be secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Got it. And will you cover Medicare Part B, deductible and co-insurance?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And will you follow Medicare guidelines for provider network status, by and bill authorization?
[AGENT][NEUTRAL] No. We don't have a network.
[AGENT][NEGATIVE] This is the gap shows there is no network.
[CUSTOMER][NEUTRAL] OK, and
[AGENT][NEUTRAL] And pre-authorization is not required either.
[CUSTOMER][NEUTRAL] OK. And will you
[CUSTOMER][NEUTRAL] OK. And will you follow all Medicare guidelines?
[AGENT][NEUTRAL] No, we don't, we don't pay anything towards Medicare. We just, uh, this is a gap insurance to the primary insurance. Whatever the primary insurance company is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And uh could you please spell out your name with your last initial and call reference number?
[AGENT][NEUTRAL] [PII]. First initial, my last name, [PII], and we don't provide reference numbers. You can use my name in today's date as a reference. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, thank you, [PII], for asking. But uh I've already, you have already provided that information I needed for the patient, and bye for now.
[AGENT][POSITIVE] Thanks for calling APL and have a great day, [PII]. Goodbye.