AccountId: 011433970860
ContactId: 4eb0d84d-5a3e-4377-aa92-fae55c6f9d7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426359 ms
Total Talk Time (AGENT): 138651 ms
Total Talk Time (CUSTOMER): 199691 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/4eb0d84d-5a3e-4377-aa92-fae55c6f9d7c_20250114T16:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Morning. Good morning. This is [PII] from dialysis Care Center admissions department. How are you?
[AGENT][POSITIVE] I'm great. How are you?
[CUSTOMER][NEUTRAL] I'm good as well, thank you for asking. I have only one member for which I need to verify insurance eligibility and benefits for outpatient dialysis. Can you please help me out?
[AGENT][NEUTRAL] I can verify benefits for you. May I have a policy number?
[CUSTOMER][NEUTRAL] Sure, the number we have is, is
[CUSTOMER][NEUTRAL] I'm sorry, 02350207.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] Sure. [PII] direct line.
[AGENT][NEUTRAL] And can you spell your first name for me?
[CUSTOMER][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] Hm, uh, that's [PII]
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is
[CUSTOMER][NEUTRAL] Heter [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of the claim. And where would place a service be?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] Outpatient calendar year lost 3500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that
[CUSTOMER][NEUTRAL] Uh, let's start with general eligibility.
[AGENT][NEUTRAL] Policies effective [PII] and it is active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and it, uh, mm, is it a commercial policy? Is it primary or secondary?
[AGENT][NEUTRAL] This is secondary.
[CUSTOMER][NEUTRAL] Active secondary insurance, and what else? Is there any group number?
[AGENT][POSITIVE] Yes, let me get it pulled up for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 19253.
[CUSTOMER][NEUTRAL] 19253. Perfect. And what is the insurance um plan name?
[AGENT][NEUTRAL] Metlink, M A D L I N K.
[CUSTOMER][NEUTRAL] Oh, is that a pla plan ma'am?
[AGENT][NEUTRAL] Yes, that's the name of the plan.
[CUSTOMER][NEUTRAL] OK, and what is the insurance name? I've never heard this insurance before.
[AGENT][NEUTRAL] American public life is the gap or secondary plan.
[CUSTOMER][NEUTRAL] American Public Life. And do you know if the insurance will cover outpatient dialysis?
[AGENT][NEUTRAL] OK, let me see if it's outlined in the policy one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And what is the difference between the gap insurance and GAP and the medical insurance, um.
[CUSTOMER][NEUTRAL] As long as I know, gap will cover.
[CUSTOMER][NEUTRAL] Gap is the insurance for your car? Is that, is that right?
[AGENT][NEUTRAL] It would
[AGENT][NEUTRAL] It follows the primary, so it will pick up the copays, the co-insurance, and our deductible up to the benefit amount.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Perfect. hmm, perfect. And the max limit is you gave me, uh, was that, uh, um, $3500 right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Oh OK, that's the maximum limit.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I'm just looking through the policy.
[CUSTOMER][POSITIVE] Perfect. And uh hm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I'm not showing any exclusions for dialysis.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, I'm not showing any exclusion, so if the primary allows this plan will allow up to the benefit amount.
[CUSTOMER][POSITIVE] OK, that's perfect. And uh what is the group name?
[AGENT][NEUTRAL] The group name is.
[CUSTOMER][NEUTRAL] This is a commercial policy.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The group is Surplus Management Inc.
[CUSTOMER][NEUTRAL] Uh, same as the primary one, right?
[AGENT][NEUTRAL] I'm not sure what the primary is until the claims are submitted.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. Serpa manage that's what we have in the primary. I already verified that Serpas management INC, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Perfect. And what else is there any authorization uh required for secondary?
[AGENT][NEUTRAL] Prior art is not required.
[CUSTOMER][POSITIVE] All right, that's perfect. And where do we need to submit the claims?
[AGENT][NEUTRAL] They will go to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. Perfect.
[CUSTOMER][NEUTRAL] [PII]. OK, let me know that down real quick. Authorization is not required and, and, and what else? Perfect. I think that's all the information I need. Is that possible for you to send all this information through fax? Is there any way?
[AGENT][NEUTRAL] Yes, you can fax if you like. It's 877.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. No, no, no, no, no, no. No, no, I'm sorry. I'm sorry. Actually, I'm asking about the, the benefits. Is that possible for you to send this benefit detail uh on our fax number? OK, no worries. No worries, now, I think, now, I think we are done. Now, I just need the call reference number.
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEGATIVE] Uh, no, we don't. No, we do not.
[AGENT][NEUTRAL] It will be my name, which is [PII] Last initial is [PII] along with today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. And uh the last thing I missed, uh, the payer ID number, is that 60801?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Alright, thank you so much, [PII] that's all the information I was looking for and you have a wonderful day ahead.
[AGENT][POSITIVE] [PII], you're so welcome and thank you for calling American Public Life. Have a great day. Bye bye.
[CUSTOMER][POSITIVE] Thanks, bye.