AccountId: 011433970860
ContactId: 4f5d3f0d-1424-4e76-8ef4-8ca5e8b9d212
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 636570 ms
Total Talk Time (AGENT): 204685 ms
Total Talk Time (CUSTOMER): 150961 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/4f5d3f0d-1424-4e76-8ef4-8ca5e8b9d212_20250514T21:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I need to verify um coverage and benefits for a patient please.
[AGENT][NEUTRAL] Sure, can I get your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Where are you calling from?
[CUSTOMER][NEUTRAL] Advanced Orthopedics of Oklahoma.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] extension [PII].
[AGENT][NEUTRAL] OK, sorry, one more time. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Extension [PII].
[AGENT][NEUTRAL] OK. And do you have the policy number?
[CUSTOMER][NEUTRAL] 02579329.
[AGENT][NEUTRAL] I'm so sorry. I'm sorry, 0257.
[CUSTOMER][NEUTRAL] 025.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 79329
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes [PII] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] I'm showing that this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] This is a Medlink policy, which means it is a secondary gap policy. So for claims, we will need the primary insurance to pay first and then Medlink may be able to cover it afterwards. So we will need the primary EOB as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, uh, for, um, specialist office visit and X-rays, does it, um, pick up anything towards that?
[AGENT][NEUTRAL] And is there anything specific you're needing?
[AGENT][NEUTRAL] You said specialist in X-rays? Let me check.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I am seeing that there is.
[AGENT][NEUTRAL] The diagnostic testing.
[AGENT][NEUTRAL] Which could include X-rays, MRI facilities.
[AGENT][NEUTRAL] The outpatient benefit.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Oh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] OK, and it would be done in the off it would be done in the office.
[AGENT][NEUTRAL] Oh, in the office? OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is a verification of benefits and not necessarily a guarantee of payment.
[AGENT][NEUTRAL] It looks like there's an inpatient benefit maximum of up to $10,500.
[AGENT][NEUTRAL] For all covered persons, so, and there's also a benefit maximum, I'm sorry, I misspoke. There's an inpatient benefit maximum of $3500.
[CUSTOMER][NEUTRAL] Does that apply to the office and outpatient services?
[AGENT][NEUTRAL] I don't see office visits on here. Let me check.
[CUSTOMER][NEUTRAL] What about other services in the office though?
[CUSTOMER][NEUTRAL] Uh, it looks like somebody previously told us that it doesn't pick up the actual office visit copay, but I guess it does have benefits for other services like if it was deductible or co-insurance or something like that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like it could do inpatient benefits treatment while confined as an inpatient.
[CUSTOMER][NEUTRAL] OK, what about because I, what about office or outpatient though is what I'm asking.
[AGENT][NEUTRAL] Not
[AGENT][NEUTRAL] OK, yeah, I'm not seeing anything for
[AGENT][NEUTRAL] There is also an outpatient benefit maximum of up to $3500 as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it does look like diagnostic testing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In an independent lab facility.
[AGENT][NEUTRAL] Is covered
[AGENT][NEUTRAL] And you said it's in an office, so I don't know about that, but there is hospital outpatient facility, MRI facility. Mhm. um I'm not seeing one specifically for in the.
[CUSTOMER][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's one of the things we should just send it in and see.
[CUSTOMER][NEUTRAL] But not OK based just based on what you told us previously, it wouldn't pick up the copay itself, but it may cover other stuff then if it's not OK, so we should just send it in.
[AGENT][NEUTRAL] It may, and since this is a gap policy, the primary insurance will need to cover it or pay for it first.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And if they deny it, then this policy will not pick it up. So when you do file a claim for this policy, you'll need the primary uh EOB or explanation of benefits from the major medical. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] And have they used anything on that 3500 for the outpatient?
[AGENT][NEUTRAL] Right, it's 30, it looks like it's up to a maximum of 3500 for inpatient and 3500 for outpatient.
[CUSTOMER][NEUTRAL] OK, have they used anything on that?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Looks like so far to date, she has only used $115 of that 4 cents.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That's for the outpatient, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, and then he said the inpatient amount is the same is it separate or is it combined or is it totally separate?
[AGENT][NEUTRAL] They are separate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, and have they used anything on that either or no?
[AGENT][NEUTRAL] Um, all the amount that I just gave you was for outpatient only. That's the only thing that they've used to date, mhm.
[CUSTOMER][NEUTRAL] OK, OK, OK, so that's alright.
[CUSTOMER][NEUTRAL] Is there any kind of a deductible or anything that they have to meet with this plan?
[AGENT][NEUTRAL] I didn't see anything about a deductible on there.
[AGENT][NEUTRAL] I am gonna go ahead and check.
[AGENT][NEUTRAL] No, ma'am, I'm not seeing anything towards the deductible. I'm sorry, uh, I'm not seeing any deductible on here.
[CUSTOMER][NEUTRAL] No, OK, so
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] It's not a deductible. OK, all right, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, the address that I have to send the claims to is the [PII]. Is that still correct?
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK great thank you and I'm sorry you said your name was [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK thank you is there a reference number?
[AGENT][NEUTRAL] We don't have a reference number, but you can use my name and last initial which is [PII] in today's date.
[CUSTOMER][POSITIVE] OK great well thank you for your help you have a great rest of your day.
[AGENT][POSITIVE] Thank you so much for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] OK, bye.