AccountId: 011433970860
ContactId: 3e4e00a5-2161-400b-9b54-c7e5dc6f3338
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318049 ms
Total Talk Time (AGENT): 174473 ms
Total Talk Time (CUSTOMER): 93780 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/3e4e00a5-2161-400b-9b54-c7e5dc6f3338_20250304T16:54_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, I would just need to verify a member's benefit information.
[AGENT][NEUTRAL] OK. Do you also need eligibility or only benefits?
[CUSTOMER][POSITIVE] Just benefits.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] I'm [PII] if you need that.
[AGENT][POSITIVE] Thank you and
[AGENT][NEUTRAL] OK. [PII], do you spell, how do you spell your first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] It is 02440284.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] And [PII], any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII] butchered it [PII].
[AGENT][POSITIVE] That's OK. I think you did excellent.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, so what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] It's durable medical equipment. I don't know if you're that matters.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max per calendar year for covered outpatient services of $5000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Because this is a supplemental policy to her primary insurance, [PII], when the claim is submitted to APO you all will also need to include a copy of her primary insurance company's explanation of benefits for us as well.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal in which you should be able to check claim status for us and have access to our EOB and our website for the portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and then just to how what percentage is covered? Would it just go to 100%?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Again, the benefit max, again, the benefit max is 5000 per calendar year for any covered outpatient services.
[CUSTOMER][NEUTRAL] With the secondary.
[AGENT][NEUTRAL] Now, on durable medical equipment, I will let you know that disposable supplies are not covered.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, DME not covered.
[AGENT][NEUTRAL] No, it's not that DME is not covered. So the any disposable supplies are not covered under the DME rider.
[CUSTOMER][NEUTRAL] Ah, and it's a CPAP stuff, yeah, OK, so.
[AGENT][NEUTRAL] The machine and stuff, but anything that is disposable. Yes, ma'am, that is, that is excluded.
[CUSTOMER][POSITIVE] like the mask cushion, yeah, OK.
[AGENT][NEUTRAL] It must be able to withstand repeated use.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I got you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] I think I got it. So the, so like her United Healthcare covers 80. Would you guys pick up the 20, I guess is my question.
[AGENT][NEUTRAL] And again, I can't guarantee that would be me verifying, you know, payment we, I can't do that. I can only provide you what the benefit is, but this policy is designed to help them with their co-pays, deductibles, and co-insurance amounts of coverage services up to that benefit maximum per calendar year.
[CUSTOMER][NEUTRAL] OK, I see up to 5000, but it, in other words, you guys pick up her primary insurance is what you do, I'm assuming just to I'm trying to clarify.
[AGENT][NEUTRAL] That is why we, right, this is a supplement to her primary insurance. So that's why we have to have their, her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][POSITIVE] Makes sense, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, I think I got it OK.
[CUSTOMER][POSITIVE] All right, perfect. All right, I appreciate it. Do you have a reference number?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am, you would actually use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, and what was your name again? I'm so sorry. It's one of those days.
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. I appreciate it, [PII] thank you.
[AGENT][POSITIVE] Um, OK, well, you're certainly very welcome. So if that's all I can help you with, thank you again for calling APLJD and I hope you have a great day.
[CUSTOMER][POSITIVE] Perfect, thank you, bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Goodbye.