AccountId: 011433970860
ContactId: 6921246d-df8a-45dd-a99b-65adb0281dc5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 163839 ms
Total Talk Time (AGENT): 87339 ms
Total Talk Time (CUSTOMER): 52378 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/6921246d-df8a-45dd-a99b-65adb0281dc5_20250220T15:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I am calling from provider's office, and I am needing to get benefits for a DME code and then also make sure we're in network with the patient's plan.
[AGENT][NEUTRAL] OK, well, I can help you with the benefits and the network. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And the member's policy number?
[CUSTOMER][NEUTRAL] 01907891.
[AGENT][NEUTRAL] And that was 01907891?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I have [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is the verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. Um, now, for durable medical equipment that is under the outpatient um benefit, the benefit for outpatient is up to $6800 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is that like his deductible or is that is out of pocket?
[AGENT][NEUTRAL] Neither. So this is a secondary insurance. So we pay towards the copay, deductible and co-insurance of cover charges after primary. So he um has $6800 each day to use towards outpatient expenses, which durable medical equipment is under that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if his primary does not cover it, you guys would not cover it then?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then if I could still just make sure if we're in network with this insurance at all.
[AGENT][NEUTRAL] Um, so for secondary insurance, there's there, we don't have a network, um, their primary does, but secondary doesn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect, um, [PII], if I could just get a reference number please.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII], and just for the call, all the information provided was a verification of benefits, not a guarantee of payment. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Nope, that is everything thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.