AccountId: 011433970860
ContactId: 4c516190-294f-47cf-a471-f69d81b7939a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 932109 ms
Total Talk Time (AGENT): 305530 ms
Total Talk Time (CUSTOMER): 371785 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/4c516190-294f-47cf-a471-f69d81b7939a_20250130T18:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hello, good afternoon to you, Miss [PII].
[AGENT][NEUTRAL] Hello, Is there anyone there?
[CUSTOMER][POSITIVE] Yes ma'am, I'm here with you. Can you hear me?
[AGENT][NEUTRAL] Oh, I can hear you now. I can now. I didn't hear anything at first.
[CUSTOMER][NEUTRAL] Hello, hello.
[CUSTOMER][NEUTRAL] Good afternoon to you, Ms. [PII]. I do apologize about that. My name is [PII]. My last initial is [PII]. I am on a recorded line for quality and training purposes, and I'm calling to verify benefits for a patient that is coming into our office for infusion therapy, and I need to verify coverage for specific procedure codes.
[AGENT][NEUTRAL] That's OK. That's.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so you're wanting to verify benefits only. You do not need eligibility, [PII], is that correct?
[CUSTOMER][NEUTRAL] Well, yes, eligibility and benefits. I just say it just tells me to say benefits, but yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Yes, ma'am. I can help you with both and [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]. That is a direct line with no extension and it's OK to leave a voicemail.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] 0243 0719.
[AGENT][NEUTRAL] Alright thank you one moment please while I get the member's information loaded.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. So first off, what is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is for [PII], I mean, [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and that date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that she is a subscriber on the supplemental policy.
[AGENT][NEUTRAL] And this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And you said that you were needing benefits for in-office treatment, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so this supplemental, this supplemental policy does not cover office visits or treatment within the office.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] Does not cover treatment.
[AGENT][NEUTRAL] Or office visits in in the office setting, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And you said they are active, correct?
[AGENT][NEUTRAL] Yes, ma'am. This policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] And it's supplemental.
[AGENT][NEUTRAL] Uh-huh. This is a supplement to her primary insurance.
[CUSTOMER][NEUTRAL] And is this a Medicare supplement?
[AGENT][NEUTRAL] It is not. This is, would be to her major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does it have any type of group name?
[AGENT][NEUTRAL] Let's see our employer group.
[AGENT][NEUTRAL] Name is
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Is [PII] and that's spelled [PII] It is one word, Holdings.
[AGENT][NEUTRAL] And the group number is 20764.
[CUSTOMER][NEUTRAL] Thank you. And is there any type of claims or address or anything?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Our claims mailing address is [PII].
[AGENT][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so again, [PII].
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. And how about a payer do you all have a payer EDI or anything?
[AGENT][NEUTRAL] It is the payer ID is 60801.
[CUSTOMER][NEUTRAL] You said 60801 correct?
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] That's correct, yes. Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And should you all end up filing a claim with APL because it is a supplement to our primary insurance, we would also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then we also have a portal that once we process a claim you should be able to check claim status [PII] by going to secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Just bear with me.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Just trying to get um.
[CUSTOMER][NEUTRAL] And does it follow the health plan guidelines for Medicare or you all?
[AGENT][NEUTRAL] No, this would, this is for her, this is for her primary.
[AGENT][NEUTRAL] This has nothing to do with Medicare. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Alright, just bear with me.
[CUSTOMER][NEUTRAL] And is, would this be any type of gap plan or limited medical plan?
[AGENT][NEUTRAL] This is a, this is essentially a gap plan. It is a supplemental policy. We are not a major medical insurance company.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, there we go I'm just gonna um.
[CUSTOMER][NEUTRAL] Updating updating.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, there we go.
[CUSTOMER][NEUTRAL] And I'm just waiting on my good old computer to load up.
[AGENT][POSITIVE] I understand, no worries.
[CUSTOMER][NEUTRAL] Alright, just give me a few more moments.
[CUSTOMER][POSITIVE] There we go, thank you, anytime computer.
[CUSTOMER][NEUTRAL] All right. So how about their, um,
[CUSTOMER][NEUTRAL] Um, their benefits.
[AGENT][NEUTRAL] OK. I get, yes, ma'am, office visits are not covered and treatment done within the office are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, so do they still have any type of individual deductibles or out of pockets?
[AGENT][NEUTRAL] Not on this policy for covered outpatient services on this plan, there's a $500 benefit max per calendar day per covered person per covered, as I stated rather for covered outpatient services with no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm just making sure.
[CUSTOMER][NEUTRAL] All right, so I am going.
[CUSTOMER][NEUTRAL] To briefly recap the information you provided me with, um, they are active and this is a gap plan.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And you did let me know that the group name was [PII].
[CUSTOMER][NEUTRAL] [PII] Holding with the group number 20764 PO Box 248,950 for [PII] um [PII] and the payer EDI was 60801 you did let me know.
[AGENT][NEUTRAL] OK, just one moment. OK, just one moment, [PII], so you've missed the last four numbers on our PO box. It's 73124-8950 and that PO box is for APL, not her employer. Just wanna clarify that.
[CUSTOMER][NEUTRAL] So you said the PO box is [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh yeah, it, it doesn't allow us to put in, it just allows us to put in the 1st 5 numbers of the zip code, which automatically pulls up [PII]. Thank you.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Mhm.
[CUSTOMER][NEUTRAL] And you did say you said that there is uh we could check the portal secured. um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] No, secured. The website is secured.
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Am public.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To check the portal to check claims, you said there's no deductible.
[CUSTOMER][NEGATIVE] And this service is not covered for the treatment of office visits.
[AGENT][NEUTRAL] Or treatment within the office setting. Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am. So it does not cover treatment or office setting treatment.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am. I'm here. It doesn't cover office visits or treatment within the office setting.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there any type of prior authorization or anything required?
[AGENT][NEGATIVE] There is not.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] All right, and.
[CUSTOMER][NEUTRAL] They don't have any.
[CUSTOMER][NEUTRAL] Just waiting on the computer to finish loading.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEGATIVE] I'm just gonna add that they are not.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And I do still have to just give um the codes and things um just to let you know it's OK if you don't take them or anything. I have to give them out. um, it's the first code is for the medication intiVo J3380. I have two admin codes 96413.
[CUSTOMER][NEUTRAL] 96365 diagnosis code is K for kilo 51.90. This is not related to cancer, um, and this will take place in a special specialty office place of service 11.
[CUSTOMER][NEUTRAL] All right. And Ms. [PII], do you have a, uh, may I have the correct spelling of your first name?
[AGENT][NEUTRAL] Yes ma'am, it is [PII] and my name along with today's date, [PII] would be your call reference number if you need one.
[CUSTOMER][NEUTRAL] OK, and do you have any type of, uh, do you have a last initial to your first name?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] S
[AGENT][NEUTRAL] [PII], is the first initial to my last name. Uh-huh.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you. And Ms. [PII], you have a lovely rest of your day.
[AGENT][POSITIVE] Yes ma'am. Well, you too, and if that's all then that I can help you with, it was my pleasure in speaking to you today, [PII], and have a wonderful afternoon and thank you again for calling APL.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][POSITIVE] You as well thank you bye.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. Bye bye.