AccountId: 011433970860
ContactId: 5de66887-1710-443f-ae28-bed4f9939776
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262239 ms
Total Talk Time (AGENT): 129382 ms
Total Talk Time (CUSTOMER): 84548 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/5de66887-1710-443f-ae28-bed4f9939776_20250516T19:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII]. I'm calling with Tandem Diabetes Care. I have a mutual patient. I was hoping to check eligibility and benefit information on for DME.
[AGENT][NEUTRAL] OK [PII], you're needing eligibility and benefits for a member and you said the eligibility or the benefit information rather was for DME is that correct?
[CUSTOMER][NEUTRAL] If I could, yeah.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It's gonna be 02566560.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And any information that is provided today will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] That is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show and again any information provided will be a verification of benefits and not a guarantee of payment. I do show that Mr. [PII] is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And he has an outpatient benefit maximum per calendar year of $3000 for covered services.
[AGENT][NEUTRAL] With no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And yeah when the claim is submitted to APL for review, [PII], we will also need to for you to send a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have reviewed and processed the claim, you should be able to check the claim status.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In our portal if you go to [PII].
[CUSTOMER][NEUTRAL] OK awesome um and then let me see I don't believe that we're in network with you guys but we are in network with our primary. Would that make us in network with you guys?
[AGENT][NEUTRAL] There is no network affiliated with this policy here at APL so it would follow his primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, perfect, um, and then is there a group name on this one? I don't seem to have one.
[AGENT][NEUTRAL] Yes, ma'am. The group is Wagner [PII].
[CUSTOMER][NEUTRAL] County, OK, and then see that covers most of it runs on a calendar year, right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It does, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and then lastly, um, do you guys require authorization for DME?
[AGENT][NEUTRAL] There is no prior authorization on this policy. No, ma'am, no prior authorization required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Amazing. um, that covers it then if I could just get the initial to your last name and a reference number.
[AGENT][NEUTRAL] Yes, actually my name along with today's date will be your reference number and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Oh, thank you so much. You have a great day.
[AGENT][POSITIVE] OK, well, if that is all I can help you with, [PII] and thank you very much and thank you again for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] Thank you. You too. Bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye bye.