AccountId: 011433970860
ContactId: 58cb7450-c657-480e-9c8b-e299624e80fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 621190 ms
Total Talk Time (AGENT): 123567 ms
Total Talk Time (CUSTOMER): 183428 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/58cb7450-c657-480e-9c8b-e299624e80fe_20250310T16:14_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, hi, good morning. My name is [PII]. I'm calling from the provider's office. This call is being recorded for quality and training, and I would like to know the information regarding the benefits for one of our patients. Can you please check it with that?
[AGENT][POSITIVE] Sure, I can assist you with benefits. Can you repeat your name? I didn't quite catch your name.
[CUSTOMER][NEUTRAL] My name is [PII] Last name of initial. I'm sorry, [PII]. May I know your name, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. And may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII]. And may I know your last name of the initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're welcome. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 0166
[CUSTOMER][NEUTRAL] 0259
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name of the patient is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what type of service is being render?
[CUSTOMER][NEUTRAL] Services are for occupation of for outpatient.
[CUSTOMER][NEUTRAL] Place of services office setting, and the billing is for professional billing.
[AGENT][NEUTRAL] OK, you said it's office setting. What type of service?
[CUSTOMER][NEUTRAL] Occupational therapy services.
[AGENT][NEUTRAL] Occupational therapy. OK, let me check and see if it's a cover service. One moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. Can you please verify is this Medicare supplemental plan or commercial PPO plan?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical. This is a commercial plan.
[AGENT][NEUTRAL] And we follow primary.
[CUSTOMER][NEUTRAL] So, I think.
[CUSTOMER][NEUTRAL] No covers uh Medicare supplement plan, is it right?
[AGENT][NEUTRAL] I'm sorry, can you repeat that a little bit slower so I understand?
[CUSTOMER][NEUTRAL] The member policy is um plan type is a Medicare supplemental plan, is it right?
[AGENT][NEUTRAL] It's a medical supplemental plan, a secondary policy, correct.
[CUSTOMER][NEUTRAL] OK, one moment. Stay on the line.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, thank you for staying on the line, so.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, OK. You said that member's policy is the Medicare supplemental plan, is it right? So it follows the Medicare guidelines. Is it right?
[AGENT][NEUTRAL] It follows the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But as per our and we are unable to verify the benefits for supplemental plan because we are out of scope for the medical supplemental plans. So, can you please verify, can you please provide me a call reference? We are unable to verify that because we are out of network, uh, out of scope is out of scope, sir.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I'm not understanding what you're saying.
[CUSTOMER][NEUTRAL] Make a supplemental plans. Can you please?
[CUSTOMER][NEUTRAL] OK, no issue. And you said that member's plan is like a supplemental plans. Can you please provide me the call reference number?
[AGENT][NEUTRAL] No, this is not a Medicare.
[AGENT][NEUTRAL] No, Mr. [PII], this is not a secondary Medicare supplemental plan. This is a secondary medical supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you are saying that this is not Medicare supplemental, is it right?
[AGENT][NEUTRAL] No, this is not a Medicare supplemental. This is a medical supplemental, which is a secondary plan to the major medical. Mhm.
[CUSTOMER][NEUTRAL] Medical supplement.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Can you please verify what is the member's policy effective date for the year of [PII]?
[AGENT][NEUTRAL] OK, sure. Bear with me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. The effective date is [PII]. It is active at the moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For on the calendar year or plan.
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] This is a calendar year benefit.
[CUSTOMER][NEUTRAL] OK. What is the plant type?
[AGENT][NEUTRAL] This is the secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Is it PP or PYS?
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Commercial plan.
[CUSTOMER][NEUTRAL] Commercial PBO BYS?
[AGENT][NEUTRAL] Commercial.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] OK. And can you please verify what is the, what about the facility participation network, participation status? Is it in network or out of network?
[AGENT][NEUTRAL] There's no network. We are the secondary to the major medical.
[CUSTOMER][NEUTRAL] Not for the medical. We are asking about the facility network patient status.
[AGENT][NEUTRAL] We don't have no network, we follow primary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Then we can, uh, is the primary insurance is in network for both facility and individual doctor. We consider it as a network, is it right?
[AGENT][NEUTRAL] I guess, y[PII], that's how you put it in, yes.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you, OK, can you please tell me what is the co-payment for outpatient occupational therapy?
[AGENT][NEUTRAL] Occupational therapy is not covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Is not covered.
[AGENT][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please provide me the call reference number for the given information?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, thank you first. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] The