AccountId: 011433970860
ContactId: 480e31ab-b1f8-44cd-bebd-a8ffb0384f72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 418010 ms
Total Talk Time (AGENT): 153462 ms
Total Talk Time (CUSTOMER): 140342 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/480e31ab-b1f8-44cd-bebd-a8ffb0384f72_20250214T16:34_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Hi, can you hear me?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII]. Last name initial, [PII]. I'm from Fol Prosthetics and Orthotics Incorporated and calling regarding eligibility for a member. Can you please assist?
[AGENT][NEUTRAL] Yes, I can um help you with eligibility, [PII]. What is your um callback number, sir, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Uh, over.
[CUSTOMER][NEUTRAL] [PII], sir.
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's policy number?
[CUSTOMER][NEUTRAL] That is 023 08152.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima. 8.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[AGENT][NEUTRAL] OK, I see that um this policy for [PII] is lapsed. The policy lapsed on [PII].
[AGENT][NEUTRAL] I'm checking though to see if there is an active policy.
[AGENT][NEUTRAL] Yes, we do have an active policy. Let me see if she is covered on it.
[CUSTOMER][NEUTRAL] OK. If she's covered, then also let me know the member ID.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the member ID is 2,454,910.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] And it's currently active? or you already said it's active. OK. What is the plan type, plan and plan name?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, the plan name is Medlink [PII]
[AGENT][NEUTRAL] And this is just to verify coverage. It's not a guarantee of payment. This is a supplemental insurance policy. It's a gap policy that helps with deductible, co-pay, and coinsurance.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $4000 and then she also has an outpatient benefit amount per calendar year of $4000.
[CUSTOMER][NEUTRAL] Is it like a maximum of $4000?
[AGENT][NEUTRAL] Per calendar year, yes.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, I, I would like to know, uh, like uh for the year [PII], uh, how much the benefit maximum was met and right now how much has been met.
[AGENT][POSITIVE] OK, I can look for you.
[AGENT][NEUTRAL] Give me just a second to pull that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Nothing was met for outpatient.
[AGENT][NEUTRAL] For the year of [PII] for inpatient.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] $636.35.
[CUSTOMER][NEUTRAL] And for this year,
[AGENT][NEUTRAL] Let me check.
[AGENT][NEGATIVE] Nothing has been met for this year at all.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] So this plan will cover both the Medicare Part B, deductible and co-insurance.
[AGENT][NEUTRAL] Uh, it covers the primary is billed first and then we're billed second, depending on what the primary pays is what we pay.
[CUSTOMER][NEUTRAL] Um, uh, since the Medicare is primary.
[CUSTOMER][NEUTRAL] Uh, I just want to make sure if this plan covers the Part B deductible and co-insurance, or I think it's not Medicare, it's uh commercial plan. OK. So, uh,
[AGENT][NEUTRAL] Yeah, it's commercial, I believe because she has um.
[CUSTOMER][NEUTRAL] This, yeah, yeah.
[AGENT][NEUTRAL] Has it through her employer.
[CUSTOMER][NEUTRAL] Got it, got it. So, uh, uh, this plan will cover primary plans, deductible and co-insurance, both.
[AGENT][NEUTRAL] Based on what is paid by the primary.
[AGENT][NEUTRAL] The primary pays first and then we pay 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understood. And is it covered at 100% or like?
[AGENT][NEUTRAL] Up to $4000.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] May I know your first name?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] And uh [PII], is this plan requires an authorization?
[AGENT][NEUTRAL] No, sir, because it's not the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh do you have a call reference number, [PII]?
[AGENT][NEUTRAL] Yes, sir. You can use my name and today's date.
[CUSTOMER][NEUTRAL] And may I know your last name's initial as well?
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] And [PII], can you give me the name, can you give me the name of your provider's office again?
[CUSTOMER][POSITIVE] All right. Thank you so much. Mhm.
[CUSTOMER][NEUTRAL] Oh, sure. It's Folk Prosthetics and Orthotics Incorporated. Starts with F A L K Folk.
[AGENT][POSITIVE] OK, thank you so much. I appreciate that.
[CUSTOMER][NEUTRAL] 01 more thing, I just want to reverify the updated member ID. It is 2,454,910.
[AGENT][NEUTRAL] Yes, that's um 2,454,910, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right then, [PII]. Thank you so much for your assistance. Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] You too [PII]. Thank you for calling APL you have a good day also.
[AGENT][NEUTRAL] Bye-bye.