AccountId: 011433970860
ContactId: 67db28c0-ca55-440e-8d2a-3a8e4deb9000
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319140 ms
Total Talk Time (AGENT): 115991 ms
Total Talk Time (CUSTOMER): 155719 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/67db28c0-ca55-440e-8d2a-3a8e4deb9000_20250619T16:25_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, good, good morning. This is [PII] calling from uh Solio Health, um, in reference to um benefits for a member.
[AGENT][NEUTRAL] Sure, I can assist you with that. Did you say your name was [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII] is your last initial, first initial of your last name, or does it go with your first name?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, no, I'm sorry. Yeah.
[CUSTOMER][NEUTRAL] It is my first initial to my last name, [PII].
[AGENT][NEUTRAL] I have a callback number for you just in case the call is disconnected, [PII].
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] And what's the policy number of the member that you're calling to verify benefits for?
[CUSTOMER][NEUTRAL] 02567750
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII] [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for what place of service inpatient, outpatient, office visit?
[CUSTOMER][NEUTRAL] It's actually for home health, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But I need to check several, well 2.
[AGENT][NEUTRAL] Is it doable medical equipment?
[CUSTOMER][NEUTRAL] It's for home infusion.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] So this policy has been active since [PII].
[CUSTOMER][NEUTRAL] Home intuition, can I
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Of [PII] and it's currently active. This is a gap insurance and the policy unfortunately does not cover home health services.
[CUSTOMER][NEUTRAL] Uh, even if I provide you with like, um, uh, a specific code, can you check if that one will fall under the DME?
[AGENT][NEUTRAL] OK. What is your procedure? Oh.
[CUSTOMER][NEUTRAL] Uh, S as in Sam, 9338.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, it's not covered under the policy.
[CUSTOMER][NEUTRAL] No. So, I heard the word gap. Um, what is the between the difference between a secondary and a gap?
[AGENT][NEUTRAL] The gap insurance assists with the deductible, co-pay, and co-insurance for services covered under the policy, and her policy covers inpatient benefits.
[AGENT][NEUTRAL] Inpatient services, outpatient services, and outpatient services consist of diagnostic testing, treatment received in the office, cancer um rider, lab, BME coverage.
[AGENT][NEUTRAL] No home health services are covered under the policy.
[CUSTOMER][NEUTRAL] OK, when you said in office, would that include like um.
[CUSTOMER][NEUTRAL] IV Suite.
[AGENT][NEUTRAL] When I say in office as in is the setting is an office visit, or office physician's office, but the treatment received in the office will be covered under there. Yes.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh, physicians, OK. OK. OK. So, OK, not.
[CUSTOMER][NEUTRAL] OK. Not infusion suits no home. OK. Um, and you say your first name is, is yeah, [PII]?
[AGENT][NEUTRAL] No. Is there anything else?
[AGENT][NEUTRAL] [PII], today's date is a reference. And that is this for cancer is the diagnosis for cancer?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, um, it's, um, for the 83.9. Let me see what that means, um.
[CUSTOMER][NEUTRAL] I think it's something with the immune immune immune system.
[AGENT][NEGATIVE] The main deficiency.
[AGENT][NEUTRAL] But no, ma'am, it's not covered under the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, OK, I appreciate it.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, I hope that's it. I'm sorry, um, I've been calling because they keep just, I'm new at this job, so I'm not sure what to ask so I've been, I've been told to call already 3 times, so you know, um.
[AGENT][POSITIVE] Well, we're here if you have to call back, so we will definitely be here.
[CUSTOMER][NEUTRAL] That, you know.
[CUSTOMER][NEUTRAL] In case I need to call back in case I need to call back.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And I told them, I said, this, uh, this patient doesn't have home infusion benefits, but they want me to ask for a specific code, so I already gave you the code and it says it's no, so.
[AGENT][NEUTRAL] They just trying to make, they wanna, they're.
[AGENT][NEUTRAL] Alright, is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] I appreciate
[CUSTOMER][NEUTRAL] No, um, I'm very surprised you're all open because most of the insurances are closed today, so I wonder how come we were not closed.
[AGENT][POSITIVE] It was a pleasure speaking with you, [PII]. Thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thanks goodbye.
[CUSTOMER][NEUTRAL] Bye.