AccountId: 011433970860
ContactId: 3763c79c-f658-49d2-aeb3-49cb29706153
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 710679 ms
Total Talk Time (AGENT): 175240 ms
Total Talk Time (CUSTOMER): 270187 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/3763c79c-f658-49d2-aeb3-49cb29706153_20250129T14:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] S calling from Flexport on behalf of the provider to obtain eligibility on a patient. And how do you spell out your name?
[AGENT][NEUTRAL] [PII] And if you could spell your first name, please?
[CUSTOMER][NEUTRAL] Last initial [PII] thank you [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you said that you're checking eligibility, [PII]?
[CUSTOMER][POSITIVE] Yeah, that is right
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] 02456700 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And I get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] direct line without any extension.
[AGENT][NEUTRAL] You gave me [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] You got it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, just give me one moment.
[CUSTOMER][NEUTRAL] So the name of that patient is [PII].
[AGENT][NEUTRAL] And you said that you wanted the effective date and if the policy is active, so the eligibility information?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, so first of all, can you help me with the effective date for this patient's plan?
[AGENT][NEUTRAL] OK, so I have that for you. The effective date is [PII]. This policy is active at this time. And did you have any other questions, y'all?
[CUSTOMER][NEUTRAL] And uh what, what type of plan is it? Does it does it plan F, plan G?
[AGENT][NEUTRAL] So Metlink policy.
[CUSTOMER][NEUTRAL] Uh, so is there any alphabet or there is no alphabet?
[AGENT][NEUTRAL] It's Medlink, a Medlink policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So is it like a supplement plan?
[AGENT][NEUTRAL] Get a supplement plan to their major medical policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Got it, uh, because there are some alphabets and supplement plans, so I'm asking there is no alphabet that is just a meddling non-standard supplement plan without any alphabet, right?
[AGENT][NEUTRAL] The type of planshaw is Metlink. No alphabet, just Metlink.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, got it. So that would be a non-standard plan without any alphabet, a meddling plan, and you guys do take care of primary's remaining coinsurance and deductible both or just the coinsurance?
[AGENT][NEUTRAL] Deductible, co-insurance, and or co-pay amounts of covered charges.
[CUSTOMER][POSITIVE] Got it. So you guys take care of deductible coins and copays everything. Thank you so much and for buying the authorization.
[AGENT][NEUTRAL] Uh covered charges.
[CUSTOMER][NEUTRAL] OK, of the allowable amount of coverage charges for authorization, Medicare notes, and PCP referral, you guys do follow Medicare guidelines. If Medicare allow you or Medicaid deny you denied, right?
[AGENT][NEUTRAL] OK, you're talking fast. I didn't understand what you said.
[CUSTOMER][NEUTRAL] For ban the authorization, medical notes for PCP referral for everything you guys do follow Medicare guidelines if Medicare allow you allow.
[AGENT][NEUTRAL] No, we didn't
[AGENT][NEUTRAL] Yeah, this has nothing to do with Medicare.
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] So the answer would be no.
[CUSTOMER][NEUTRAL] Whose guidelines do you guys follow them?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] As far as following Medicare's guideline, it's, no, we do not, because it's not Medicare.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Then whose guidelines do you guys follow?
[AGENT][NEUTRAL] OK, so this is a meddling policy. It's a supplemental plan, secondary to the major medical policy. So, we're in 2nd position.
[CUSTOMER][NEUTRAL] I know this is a supplemental plan.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I know this is a supplement plan and I know this is a meddling policy and I even do know that you guys are secondary to Medicare, but the thing is that in supplement plans, all the supplement plans, the plan follow Medicare guidelines because Medicare is the primary.
[AGENT][NEUTRAL] We're not secondary to Medicare, we're secondary to the major medical plan.
[CUSTOMER][NEUTRAL] OK then whose guidelines do you guys follow? That is what I'm asking you.
[AGENT][NEUTRAL] OK, we follow the major medical policy since we're secondary to the major medical plan.
[CUSTOMER][NEUTRAL] to
[CUSTOMER][NEUTRAL] Provide they can buy and right.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Provide they can buy and bill, right?
[AGENT][NEUTRAL] What do you mean when you say that?
[CUSTOMER][NEUTRAL] Can the provider use the drug from his own stock and then bill it?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] And why is that so? Because that's uh.
[AGENT][NEUTRAL] That's part of policy. That's part of the policy.
[CUSTOMER][NEUTRAL] No, no, because that I got it. That's for the policy, but that drug is not like available in the pharmacy, so where should we get that drug from? Can you suggest me any place?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, we cannot make any suggestions.
[CUSTOMER][NEUTRAL] If you don't have any place, so we have to we get that like that injection from, where should we get that from?
[AGENT][NEUTRAL] Sir, I cannot advise.
[CUSTOMER][NEUTRAL] Can I talk to any of your senior representative or your supervisor please?
[AGENT][NEUTRAL] Sure, 11 moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what office are you calling from, [PII]? What's the name of the facility or hospital?
[CUSTOMER][NEUTRAL] Uh, the name of the facility is, just give me one moment.
[CUSTOMER][NEUTRAL] Baptist Health Medical Group.
[AGENT][NEUTRAL] OK, and are you prepared to put your supervisor on the phone so that they can speak with your supervisor as well?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, I do want to speak with them because I just have some concerns and I do want to speak with your supervisor please.
[AGENT][POSITIVE] No, no, not a problem.
[CUSTOMER][POSITIVE] Thank you, no problem.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] put an off one time.
[CUSTOMER][NEUTRAL] Yeah, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] See you guys um.
[CUSTOMER][NEUTRAL] and I believe the package will be just one.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And they do have
[CUSTOMER][NEUTRAL] 7990.
[CUSTOMER][NEUTRAL] So if you can provide me.
[AGENT][NEUTRAL] I'm waiting for a response and then I'll get you connected. I gave them the skinny of this conversation so they're aware.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Sorry, can you repeat that?
[AGENT][NEUTRAL] Give me one moment, [PII].
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] Transferring you one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That and
[CUSTOMER][NEUTRAL] APL, this is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], this is me.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, the guy on the phone, his name is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And he was basically needing eligibility and he's wanting to know if the provider can buy and build the the prescription, and I told him no. He asked me if we follow Medicare's guidelines. I told him no. This is a Metlink policy secondary to the major medical plan.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And he says, well, you have to follow it. So he says, who guidelines do you follow? I said, well, this is a supplement plan secondary to the major medical policy. So, I mean, you know.
[CUSTOMER][NEUTRAL] Yeah, I mean.
[AGENT][NEUTRAL] Um, that's the skinny of it, so he wants to speak with a supervisor.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] Um, it's 245.
[AGENT][NEUTRAL] 6700.
[AGENT][NEUTRAL] That should be for [PII] or [PII] Boy.
[CUSTOMER][NEUTRAL] Oh, I wonder why she's on me. I guess it's none of my business, but I wonder why she's on Medicare.
[AGENT][NEGATIVE] She's not. They get it confused. She's not.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, got you, got you, OK.
[AGENT][NEGATIVE] She's not. She's not.
[CUSTOMER][NEUTRAL] All right, then you can send him on to me.
[AGENT][POSITIVE] Thank you.