AccountId: 011433970860
ContactId: 20185e4c-13ae-441c-9feb-60dd8e587f53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473980 ms
Total Talk Time (AGENT): 166564 ms
Total Talk Time (CUSTOMER): 182115 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/20185e4c-13ae-441c-9feb-60dd8e587f53_20250220T18:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to check member eligibility and benefits.
[AGENT][POSITIVE] Alright, [PII], I'm happy to check on benefits and eligibility today. Do we have a policy number?
[CUSTOMER][NEUTRAL] Uh yes. Um, it's 01367433.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][POSITIVE] Thank you so much. And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What's the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is, where are you? January [PII].
[AGENT][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] Alright, [PII], let me read this number back to you, make sure I copied it down right. I copied policy number 01367433.
[CUSTOMER][NEUTRAL] Yes, and then there's letter ML and the number 8.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Yeah, it doesn't pull up that member's information. I can try and search by their name or social, um, if you wanna give me their name if you don't have their social again.
[CUSTOMER][NEUTRAL] Oh yeah, I have the name. First name is [PII] Last name is [PII], [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] All right, thank you so much, [PII]. So it looks like the patient does have an active plan. The policy number that I have is 01637433.
[CUSTOMER][POSITIVE] Mm I see. OK, thank you.
[AGENT][NEUTRAL] Yeah, so just the, it looks like the 3 and the 6 at the beginning transposed there.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the effective date on this is [PII].
[CUSTOMER][NEUTRAL] In [PII] and is this a supplemental plan?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, we're the secondary insurance, so it would cover like deductible, co-pay, and co-insurance. The primary does not.
[CUSTOMER][NEUTRAL] I see. What's the name of this supplemental plan?
[AGENT][NEUTRAL] It's a medlink plan.
[CUSTOMER][NEUTRAL] Medlink.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Midlink plan, uh, so this is a true secondary, not a supplemental.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm, OK. So, does that mean, um, this will cover or will pick up whatever is left by Medicare up to the allowed amount?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And visit limit, is there a visit limit?
[AGENT][NEUTRAL] Uh, let me take a look here.
[AGENT][NEUTRAL] There's no office visit limit. The outpatient benefit max for the calendar year is 2500.
[CUSTOMER][NEUTRAL] What is that called? The 2500?
[AGENT][NEUTRAL] Anything that would fall under outpatient so like office visits, um, anything that's not like an inpatient stay at a hospital.
[CUSTOMER][NEUTRAL] Uh, so it's like a threshold amount.
[AGENT][NEUTRAL] Correct, it's only gonna cover up to 2500. Anything after that, it would not cover.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] As of now, how much so far? can you check on that?
[AGENT][NEUTRAL] Uh, yeah, absolutely, let me take a look and see if they've used so far.
[AGENT][NEGATIVE] Looks like nothing has been used for 2025.
[CUSTOMER][NEUTRAL] OK. So as of this um day, nothing is used yet. OK. And is there like an in or out of network or it doesn't matter as long as provider accepts Medicare?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, exactly.
[CUSTOMER][NEUTRAL] Mm, I see. And no visit limit, right? Just based on medical necessity.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] No requirements as well like referrals, authorizations.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me note that.
[CUSTOMER][NEUTRAL] OK, and this is once again secondary Medicare is primary.
[CUSTOMER][NEUTRAL] APL is secondary. Where can we submit the claims? Can I have the payer ID and claims address?
[AGENT][NEUTRAL] Absolutely, uh, the payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claims mailing address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and this number by the way is a subscriber of this plan, right?
[AGENT][POSITIVE] Uh yes, that is correct.
[CUSTOMER][NEUTRAL] And this plan runs in a calendar year or a plan year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Calendar is there also a group number for billing?
[AGENT][NEUTRAL] Oh, let me take a look one moment.
[AGENT][NEUTRAL] Uh, group number is going to be 20406.
[CUSTOMER][NEUTRAL] Got it. All right. Thank you, [PII]. Just wanted to confirm, this plan will pick up or cover whatever is left by Medicare up to the allowed amount. But over anything over the threshold amount of 2500 would be member's responsibility, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Got it, thank you, sir uh can I have the initial of your last name and call reference number please?
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date. The last initial my name is [PII].
[CUSTOMER][NEUTRAL] OK. This date, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.