AccountId: 011433970860
ContactId: 666c6bfa-971a-4e07-af5d-1a593ca47df7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420299 ms
Total Talk Time (AGENT): 131036 ms
Total Talk Time (CUSTOMER): 178614 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/666c6bfa-971a-4e07-af5d-1a593ca47df7_20250205T21:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. Um, actually, I just need to check the patient's eligibility and benefit. Can you please help me out for that?
[AGENT][POSITIVE] Sure, and I can assist you with benefits. Um, first, I'll need a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] OK. It is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. Now I need the member's policy number, please.
[CUSTOMER][NEUTRAL] Yeah, it is 01829100 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah. Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, for outpatient, we cover up to $500 per day and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Did you
[CUSTOMER][NEUTRAL] OK, uh, so is this a secondary insurance for this number?
[AGENT][NEUTRAL] Yes, ma'am, this is.
[CUSTOMER][NEUTRAL] OK and um so.
[CUSTOMER][NEUTRAL] Uh, do you know what is the primary insurance for this number?
[AGENT][NEUTRAL] No, ma'am. We don't have that information until we receive claims from the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, fine. And um uh is this uh like Medicare supplement plan?
[AGENT][NEUTRAL] Yes, ma'am, it is.
[CUSTOMER][NEUTRAL] OK, so will you cover the Medicare Part B deductible and 20% co-insurance?
[AGENT][NEUTRAL] Um, we work with, yes, ma'am. Well, it depends. We would have to receive the claim from the primary insurance company. The provider would have to submit the primary, um, insurance company explanation and benefits along with the claim.
[CUSTOMER][NEUTRAL] OK just a minute
[CUSTOMER][NEUTRAL] OK, thank you so much for waiting and um just one thing I just need to ask uh for this number it's showing primary as Cigna. So if they um provide the claim and if they submit the claim, will you cover it?
[AGENT][NEUTRAL] Yes, ma'am. If it's covered under the policy, we can't guarantee payment over the phone, but for outpatient services that are covered, we cover up to $500 per day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a minute.
[CUSTOMER][NEUTRAL] So, um, what will be the benefit for MRI scan?
[AGENT][NEUTRAL] Where will it take place? Will it take place in an outpatient facility?
[CUSTOMER][NEUTRAL] Yeah, uh.
[AGENT][NEUTRAL] Yeah we'll cover.
[CUSTOMER][NEUTRAL] It is a specialist office.
[AGENT][NEUTRAL] OK, if it takes place in the provider's office, let's see if there's coverage.
[CUSTOMER][NEUTRAL] Mhm yeah.
[AGENT][NEUTRAL] OK. Yes, ma'am. If it takes place in the provider's office, we cover up to $500 per day.
[CUSTOMER][NEUTRAL] OK. Uh, is this a patient, uh, Nikisha with this, uh, benefits?
[AGENT][NEUTRAL] Yes, these are.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, just for the clarification, uh, so if the Cigna, uh, submit the claims and um it, uh, you will cover the, like, uh, you will cover the full amount. Uh, and if that is uh outpatient facility or specialist office, anything else, but you will collect the $500 copay per day, right?
[AGENT][NEUTRAL] We will cover up to $500. Yes, ma'am. If the service is covered under the policy, the claim would have to be reviewed first.
[CUSTOMER][NEUTRAL] OK, so, um, anyway, uh, um, if they submit the claims, then also you will collect the $500 copy if they didn't and, uh, the same will be collected, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so $500 is uh the fixed one, right?
[AGENT][NEUTRAL] Right, for outpatient services, we cover up to 500 per day for coverage for covered services.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, mm.
[CUSTOMER][NEUTRAL] And uh what type of plan is this? May I know the plan name?
[AGENT][NEUTRAL] It's Medlink M E D L I N K.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][POSITIVE] No problem.
[CUSTOMER][POSITIVE] OK, thank you so much for your assistance and can I get your name? Could you please spell it out?
[AGENT][NEUTRAL] My name is [PII]. It's spelled [PII] My last initial is [PII], and my name and today's date is the reference number for the call. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Pretty much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, that's it, thank you so much for that.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Mhm bye.
[AGENT][POSITIVE] Thank you.