AccountId: 011433970860
ContactId: 29500925-7aba-4330-a3a0-9696f70323d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276519 ms
Total Talk Time (AGENT): 101296 ms
Total Talk Time (CUSTOMER): 152436 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/29500925-7aba-4330-a3a0-9696f70323d3_20250416T14:51_UTC.wav
--------------------------------------------
[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 from uh Electromed and I had a couple of questions about a patient uh gap plan.
[AGENT][NEUTRAL] OK, I can assist with that, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and may I have the policy number?
[CUSTOMER][NEUTRAL] 02141248 M as in Mike L as in lemon uh and then the number 8.
[AGENT][POSITIVE] OK, thank you, [PII].
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you very much for that. I have the member pulled up and you have questions regarding the plan, I can help you with that.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I think um.
[CUSTOMER][NEUTRAL] Because we had called uh back in September about this plan September of last year and I think there may have been some misunderstanding miscommunication uh the notes from them said that this plan would cover.
[AGENT][NEUTRAL] Actually,
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All deductible co-insurance co-pay out of pocket max left over from her primary um major medical plan but uh judging by the I guess the explanation of benefits and stuff that seems to not be the case. I just wanted to clarify that.
[AGENT][NEUTRAL] OK. We are a supplemental medical policy. We do help with the major medical deductible, co-pay and co-insurance based on coverage with us. Now, you say that you have a an EOB. Can I have that claim number so I can look at that claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, let me pull it up. I'm, I'm not in the actual billing department. I'm just a patient account liaison, so I was just trying to get some answers for her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Was it like maybe for an office visit or if it was like a.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Um, it's for a piece of durable medical equipment, so, um, yeah, for, for DME and so her primary plan has a very high deductible, uh, but the, the medical equipment is quite, um, expensive, so obviously I just wanna, you know, make sure that.
[AGENT][NEUTRAL] So DME, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have
[AGENT][NEUTRAL] Now, she does have
[CUSTOMER][POSITIVE] The right information for her.
[AGENT][NEUTRAL] OK, she does have a writer on the policy that help with covered DME and that will pay up to the outpatient max for the year.
[AGENT][POSITIVE] Along with other covered outpatient services, but she does have a benefit to help with covered DME.
[AGENT][NEUTRAL] And actually it's a per calendar day max for this plan.
[CUSTOMER][NEUTRAL] OK, per calendar day max, um, and what, what is that?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, um, please note the verification of benefits provided does not guarantee payment. We pay up to $500 per calendar day for coverage services.
[CUSTOMER][NEUTRAL] OK, OK, got you. OK, so that's probably where then the confusion was because that with her primary plan and the deductible being so high, the there's a few.
[CUSTOMER][NEUTRAL] Statements I think that were like $1160 so that would only.
[CUSTOMER][NEUTRAL] So this plan would only pay $500 towards that.
[CUSTOMER][NEUTRAL] Um, per calendar day and then so potentially she would have like still $600 remaining if it was like.
[AGENT][NEUTRAL] Well, it all, it all depends even though we pay 5 up to $500 per day. It all depends on how much is applied, so it may not be the 5 the total $500 applied, it may be $250 but that falls within that $500 per day per calendar day. But um, yes ma'am.
[CUSTOMER][NEUTRAL] Sure, sure, it won't be more than 500.
[AGENT][POSITIVE] Correct, per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][POSITIVE] All right, I appreciate the information. I think that was uh that was the clarification we needed.
[AGENT][POSITIVE] OK, you're welcome, [PII]. You're welcome. Anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, no, that would be all, thanks so much, [PII].
[AGENT][POSITIVE] You're welcome and thank you for calling APL have a good day bye.
[CUSTOMER][NEUTRAL] Bye bye.