AccountId: 011433970860
ContactId: 2b441a10-09f0-4397-b764-a5fa2075635e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471589 ms
Total Talk Time (AGENT): 183848 ms
Total Talk Time (CUSTOMER): 212835 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/2b441a10-09f0-4397-b764-a5fa2075635e_20250206T19:25_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Oklahoma foot and ankle specialist, and we have a patient here that um says they have insurance with you guys. Do you guys do medical insurance as well?
[AGENT][NEUTRAL] We do, mhm.
[CUSTOMER][NEUTRAL] OK, um, he gave me several policies he wasn't sure which one it is, um.
[CUSTOMER][NEUTRAL] Could I don't know is there is there a way that we can verify this?
[AGENT][POSITIVE] Sure, I can definitely help you with.
[CUSTOMER][NEUTRAL] So I can get any benefits and stuff for him?
[AGENT][POSITIVE] So I can definitely help you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected and um any of the policy numbers um that you have? I just need one.
[CUSTOMER][NEUTRAL] OK, OK, um, the phone number is [PII].
[CUSTOMER][NEUTRAL] [PII] and there's no extension?
[CUSTOMER][NEUTRAL] That's a direct line.
[CUSTOMER][NEUTRAL] And then um do you know like what it would start with would will it start with like a letter or?
[AGENT][NEUTRAL] So our policies start with a 01 or 02, it may have an ML 7 or 8 at the end.
[CUSTOMER][NEUTRAL] OK, I do have a 02.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's OK, so it's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII], and his birthday is [PII].
[AGENT][POSITIVE] Thank you for that, and I am showing that the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. So this is a hospital indemnity policy, but there are additional benefits to it. Um, would you all be considered like outpatient? Is this going to be inpatient, like what would, what would be done?
[CUSTOMER][NEUTRAL] OK, so basically,
[CUSTOMER][NEUTRAL] I have basically we just called it, you know, just to make sure like the durable medical equipment. I don't know if you do that because we're a foot doctor or podiatrist.
[AGENT][NEUTRAL] So I'm not showing DMV.
[CUSTOMER][NEUTRAL] I don't know if he has benefits for that.
[AGENT][NEUTRAL] I'm not showing DME coverage um on the on his secondary on this policy I should say. Um, I don't know if he has another insurance policy, but for the hospital indemnity, there's no durable medical equipment coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Now does he have like a?
[CUSTOMER][NEUTRAL] A specialist copay like and and you know like an office visits but for specialists.
[AGENT][NEUTRAL] Um, so there's no co-pay or deductible for the um hospital indemnity policy, so it's a limited medical benefit policy. So for physician office, which does include specialists, the policy will pay up to $50 per visit with a max of 4 visits per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, yeah, and just the offices it's alone are like $100 so.
[CUSTOMER][NEUTRAL] Um, mhm.
[CUSTOMER][NEUTRAL] OK, so basically this policy wouldn't cover this offices since it's durable medical equipment, right?
[CUSTOMER][NEUTRAL] Or it just won't cover those things at all?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Well, no, so if you were to file the claim and it has the office visits on it, he, he does have those office visit benefits up to 4 per calendar year now. The durable medical equipment, if you file, it will most likely be denied because there's no coverage for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and so he, but he doesn't have a DME deductible?
[AGENT][NEUTRAL] There's no deductible or co-pay on this on the policy at all because it's a limited medical policy.
[CUSTOMER][NEUTRAL] OK, so I'm just gonna write here everything is not covered.
[CUSTOMER][NEUTRAL] And no copay, OK.
[CUSTOMER][NEUTRAL] And um do you know if it um does it have a group number because we asked him to send us a car you know like a picture of it but he didn't do that so I don't know if there's a group number on there that I can just write down on my paper that we have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure. So the group number is 70083.
[CUSTOMER][NEUTRAL] OK, I'm trying to say no, he's not diabetic, OK.
[CUSTOMER][NEUTRAL] Alright, and does he have a co-insurance for this?
[AGENT][NEUTRAL] Um, no, so it's just like a list of covered services and then the amount the the policy would pay for that benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I'm just gonna be here no DME coverage.
[CUSTOMER][NEUTRAL] OK, let me see what he's coming in for, um.
[CUSTOMER][NEUTRAL] OK, so since we are a podiatrist, we do like nail trimming. Do you know if that will be covered on there excuse me.
[CUSTOMER][NEUTRAL] Would that be covered for nail trim?
[AGENT][NEUTRAL] So everything on the, everything on the policy is basically where it's done, not so much what's done. So for that physician office, no matter what's done at that visit, the max that the policy would pay is the $50 per.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, visit up to 4 per calendar year.
[CUSTOMER][NEUTRAL] 4 visits per calendar year OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] And is this um an HMO policy or PPO or do you know?
[AGENT][NEUTRAL] Um, I do, it's neither, so a limited medical policy doesn't have a network, most of the time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Unless it's
[CUSTOMER][NEUTRAL] Doesn't have a
[AGENT][NEUTRAL] I'm gonna check with this one to see if it has the PPO added.
[CUSTOMER][NEUTRAL] So you said it was limited medical. What was that you said can you repeat that?
[AGENT][NEUTRAL] Yes, so a hospital, a hospital indemnity policy is a limited medical policy.
[CUSTOMER][NEUTRAL] Limited medical policy. I just wanna write this down because this will go to billing and I just, you know, wanna make sure I get my.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] T's crossed and my dots.
[AGENT][NEUTRAL] It's fine. So
[AGENT][NEUTRAL] So it doesn't have it, um, most of them do not have networks unless they're added. This one does have the PPO network added through multi-plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per visit.
[CUSTOMER][NEUTRAL] 4 minutes OK.
[CUSTOMER][NEUTRAL] Alright, I just wanted to get.
[CUSTOMER][NEUTRAL] All right now um that should be all if um I can just get like a reference number.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Um, so again, that's [PII], first initial and my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, alrighty well I thank you for that information. I appreciate it.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You as well thank you mhm bye.
[AGENT][POSITIVE] You're welcome. Bye bye.