AccountId: 011433970860
ContactId: 244a1265-1b3a-462e-ad44-ab4057968f11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351549 ms
Total Talk Time (AGENT): 116996 ms
Total Talk Time (CUSTOMER): 137702 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/244a1265-1b3a-462e-ad44-ab4057968f11_20250619T15:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. Um, this is [PII] calling from um provider um site regarding benefits for home infusion on a member.
[AGENT][NEUTRAL] I can verify benefits. May I have a policy number?
[CUSTOMER][NEUTRAL] 02567750
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this, where would the place of service be?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, home
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, well, home or, uh, IV suite, um, so if you can provide me with both.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Just gonna pull the policy up one moment.
[AGENT][NEUTRAL] And this was for infusion services?
[CUSTOMER][POSITIVE] Yes ma'am mhm home infusion, yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just waiting on the policy to load one moment.
[CUSTOMER][NEUTRAL] Sure. Mhm.
[AGENT][NEUTRAL] OK, so for any home services, it has to be under the DME benefit and that does not fall under the DME.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So for.
[AGENT][NEUTRAL] If they are.
[AGENT][NEUTRAL] Treatments received in the doctor's office are outpatient. It will fall under the outpatient and it has a benefit amount of $5000 for the calendar year.
[CUSTOMER][NEUTRAL] OK, so doctor's office or outpatient, right? You're saying um it will cover up to 5000?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 25,000. Monique, is this a uh Medicare supplement plan or is this a true secondary? What type of plan is this?
[AGENT][NEUTRAL] Yes, this is their secondary plan. It follows the primary, so it will pick up the copays, the co-insurance, and our deductibles up to that benefit amount.
[CUSTOMER][NEUTRAL] OK. So nothing to do with Medicare supplement, right? Because um I, OK, OK, cause I, I, I just wanna make sure because um I had to Google it and the Google thing says um what it says, it says, um.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Where appears uh to be uh it's a it's a supplement insurance for brokers or APL American Public Life. So that's why I'm I'm, I need to make sure cause I said the patient doesn't have Medicare, but I mean, I just need to ask.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am. If they do have Medicare or Medicaid, it would be 3rd. This plan will always be secondary.
[CUSTOMER][NEUTRAL] OK, secondary, OK. And it's just um.
[CUSTOMER][NEUTRAL] 5, up to $5000. And how much, how much has the patient um accumulated to the $5000 please?
[AGENT][NEUTRAL] One moment, I'll pull that up.
[AGENT][POSITIVE] As of today, I'm sorry.
[AGENT][NEUTRAL] Come on, it's still spinning.
[AGENT][NEUTRAL] $1,868.45 has been applied towards the outpatient benefit.
[CUSTOMER][NEUTRAL] OK, $1,867.45. OK, applied.
[AGENT][NEUTRAL] 1868.45.
[CUSTOMER][NEUTRAL] I'm sorry. OK. OK. Yeah. OK.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] And then um after she meets the $5000 no more coverage.
[AGENT][POSITIVE] Correct. It becomes patient's responsibility.
[CUSTOMER][NEUTRAL] Patient responsibility, OK.
[CUSTOMER][NEUTRAL] OK. Uh, may I have the spelling of your first name, [PII]? I just wanna make sure I have it right, [PII].
[AGENT][NEUTRAL] [PII] along with today's date will be your reference number.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you, ma'am. Thank you very much. Have a great day.
[AGENT][NEUTRAL] Maybe
[AGENT][POSITIVE] You're so welcome. And thank you for calling American Public Life, Nettie. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Yes ma'am, thanks bye bye.