AccountId: 011433970860
ContactId: 4f456e92-c467-4b85-848c-1de32d362665
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377899 ms
Total Talk Time (AGENT): 177377 ms
Total Talk Time (CUSTOMER): 157450 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/4f456e92-c467-4b85-848c-1de32d362665_20250110T20:41_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], good afternoon. This is [PII] from Dallas Care Center admissions department. How are you?
[AGENT][POSITIVE] I'm doing well, thank you for asking. How are you today?
[CUSTOMER][POSITIVE] I'm good as well thank you so much for asking. So I'm looking for eligibility and benefits for one of the member. I need to check. Can you please help me out?
[AGENT][POSITIVE] It would be my pleasure to assist you, and do you mind spelling your name for documentation purposes?
[CUSTOMER][NEUTRAL] Sure. Mhm. That's [PII].
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number in case we get disconnected please?
[CUSTOMER][NEUTRAL] Hm. It is [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] That is 02350207.
[AGENT][NEUTRAL] 02350. What were the last four? I apologize.
[CUSTOMER][NEUTRAL] 207.
[AGENT][NEUTRAL] All right, thank you. And [PII], what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] He, Heter [PII]. Date of birth, [PII].
[AGENT][POSITIVE] All right, thank you. And I do have the patient's policy pulled up. How can I help you today?
[CUSTOMER][NEUTRAL] Um, looking for eligibility and benefits for our patient dialysis.
[AGENT][NEUTRAL] All right, thank you, and I can help you with that. Her policy is active. The effective date is [PII].
[AGENT][NEUTRAL] And this is a secondary policy to her primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She does have outpatient coverage up to $3500. That is a per calendar year benefit and also that is a verification of coverage that is not a guarantee of payment. Anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mm, do you know which one is primary? Is that Blue Cross Blue Shield of Illinois?
[AGENT][POSITIVE] I can check that for you.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] I do have Blue Cross Blue Shield of Illinois.
[CUSTOMER][NEUTRAL] Alright, and that that's that's also commercial I believe, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And do you know if this member have any um part, Medicare part?
[AGENT][NEUTRAL] I don't. You would need to contact the patient, but we're secondary to Blue Cross.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Hm, OK, no worries. Hmm.
[CUSTOMER][NEUTRAL] Perfect. And um what is the claim submission address and electronic payer ID number?
[AGENT][NEUTRAL] The claim submission address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the payer ID is 60801.
[CUSTOMER][NEUTRAL] Perfect. 0801. And what is the insurance and plan name?
[AGENT][NEUTRAL] The insurance name is APL. That's A as in apple, P as in Paul, L as in Lima.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] APL insurance, that's what you call it.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. And the, and the plan name is?
[AGENT][NEUTRAL] It's a secondary.
[AGENT][NEUTRAL] Gap policy.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh, it will cover outpatient dialysis, right?
[AGENT][NEUTRAL] It does cover outpatient services up to that benefit amount given.
[CUSTOMER][NEUTRAL] Oh, OK. And it will also cover as out of network?
[AGENT][NEUTRAL] This policy does not have, uh, participate in a network.
[AGENT][NEUTRAL] It follows the guidelines of the Nature Medical.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] OK, perfect. And the last thing I need to know is.
[CUSTOMER][NEUTRAL] Um, the effective date?
[AGENT][NEUTRAL] The Effective date on the policy is [PII].
[CUSTOMER][POSITIVE] [PII]. Same as the Blue Cross Blue Shield one. Perfect. And um
[CUSTOMER][NEUTRAL] Uh, one more thing I need to confirm before leaving.
[CUSTOMER][NEUTRAL] Uh, this policy is through an employer or individual marketplace.
[AGENT][NEUTRAL] It is through through the patient's employer.
[CUSTOMER][NEUTRAL] And can you please provide the name of that group?
[AGENT][NEUTRAL] The group name is.
[AGENT][NEUTRAL] 19253
[CUSTOMER][NEUTRAL] 19253. That's it? Is that the company name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, that's the group name. The group, the group name is Surplus Management. I apologize.
[CUSTOMER][NEUTRAL] Surplus management.
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Can you please check if we are in network or out of network or it does not matter?
[AGENT][NEUTRAL] With our policy, there's no network participation.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So you guys will cover everything even as out of network, right?
[AGENT][NEUTRAL] If if the primary insurance provides benefits or applies something to their deductible, co-pay or co-insurance, and it is a covered benefit according to the guidelines of the policy, then we can consider the claim for payment.
[CUSTOMER][NEUTRAL] Mm, OK. Because the primary insurance also shows the group name as Sir Plus Management, same as the one you, you gave me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] OK, thank you so much for all this information. Now I am ready for call reference number.
[AGENT][NEUTRAL] Call reference number is my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. That's all I was looking for and you have a wonderful day ahead.
[AGENT][POSITIVE] Well, [PII], it's been my pleasure to help you with the eligibility and benefits. Thank you for calling APL, and I hope you have a wonderful day as well and a happy weekend.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah