AccountId: 011433970860
ContactId: 502e2b38-5c39-465c-a868-0504bcbcf1ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313880 ms
Total Talk Time (AGENT): 116163 ms
Total Talk Time (CUSTOMER): 94008 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/502e2b38-5c39-465c-a868-0504bcbcf1ea_20250124T16:12_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and the last name initial is [PII]. I'm calling on a recorded line for quality and training purpose for the doctor [PII]. I need to obtain medical benefits and eligibility for our patient.
[AGENT][POSITIVE] OK, perfect. I'd love to help you with some eligibility and benefits today. Do you mind if I get a good call back number from you?
[CUSTOMER][NEUTRAL] Yes, my good callback number is [PII] with an extension of [PII].
[AGENT][NEUTRAL] Thank you and what's the policy number we want to look at today?
[CUSTOMER][NEUTRAL] Yes, the member ID is 01852130 M as in Mike, L as in Lima, and number 8.
[AGENT][POSITIVE] Thank you and give me just a moment to get that pulled up for you.
[AGENT][POSITIVE] Awesome and could you verify for me please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Wonderful. I do see Ms. [PII] here. She is current and active with us and um as far as
[AGENT][NEUTRAL] Benefis go were we looking at inpatient or outpatient benefits today?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Perfect. I do wanna let you know any benefit information I give over the phone will just be a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK. May I know the policy's effective date?
[AGENT][NEUTRAL] Uh,
[AGENT][POSITIVE] Oh yes, I'm so sorry. um, let me go back to that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Her effective date is [PII].
[CUSTOMER][NEUTRAL] Is there any future termination date?
[AGENT][NEUTRAL] No, she's still active.
[CUSTOMER][NEUTRAL] OK. May I know the plan runs on the plan or the calendar year?
[AGENT][NEUTRAL] It is a calendar year plan, yes.
[CUSTOMER][NEUTRAL] Thank you. Can I get the group number for billing purpose?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The group number with us is going to be.
[AGENT][NEUTRAL] 24,050
[CUSTOMER][NEUTRAL] Thank you. May I know the plan name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. So this is a non-standard supplement plan?
[AGENT][POSITIVE] It is a what? I'm so sorry.
[CUSTOMER][NEUTRAL] It is a non-standard supplement plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And may I know, will you follow Medicare guidelines?
[AGENT][NEUTRAL] Uh, I don't guidelines for what?
[AGENT][NEGATIVE] I don't believe so.
[CUSTOMER][NEUTRAL] May I know, will you follow Medicare guidelines?
[AGENT][NEGATIVE] I, I don't believe so.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The Medicare guidelines are for coordination of benefits, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, we're secondary insurance so we don't do that because we're supplemental.
[CUSTOMER][NEUTRAL] OK. May I know, will you follow Medicare guidelines for provider network status by and build step therapy and authorization?
[AGENT][NEUTRAL] I'm so sorry you spoke a little too fast and I'm not sure I understood what you said.
[CUSTOMER][NEUTRAL] OK. May I know, will you follow Medicare guidelines?
[AGENT][NEUTRAL] I
[AGENT][NEGATIVE] I don't believe so, no.
[CUSTOMER][NEUTRAL] OK. May I know will you cover Medicare Part B deductible and co-insurance?
[AGENT][NEUTRAL] Um, we are designed to only follow the major medical insurance that they have with their policy, not with Medicare.
[AGENT][NEUTRAL] Where it looks like they have United Healthcare and that's what we're designed to follow for them.
[CUSTOMER][NEUTRAL] OK. You are secondary, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. May I know, will you cover Medicare Part B deductible and co-insurance?
[AGENT][NEUTRAL] We only cover their major medical that they have listed with us as United Healthcare.
[CUSTOMER][POSITIVE] OK, thank you. Thank you for assisting me. Would you please spell out your name with the last initial of your name?
[AGENT][POSITIVE] Yes, absolutely. It's [PII], first initial, last name, [PII].
[CUSTOMER][POSITIVE] Thank you. Can I get the call reference number for our good call?
[AGENT][NEUTRAL] Yeah, reference number is just my name in today's date.
[CUSTOMER][POSITIVE] OK. Thank you for assisting me today. Have a great day. Bye for now.
[AGENT][NEUTRAL] You too bye bye.