AccountId: 011433970860
ContactId: 6ed07ad3-95a6-4e0d-b39d-2f2e09620122
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329369 ms
Total Talk Time (AGENT): 133081 ms
Total Talk Time (CUSTOMER): 142285 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/6ed07ad3-95a6-4e0d-b39d-2f2e09620122_20250116T16:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Last initial is [PII]. I'm calling from Amgen Support Plus on a recorded line at the request of Doctor [PII]'s office to verify benefits and eligibility for [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. [PII]. And what was that date of birth again, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you ma'am and Miss [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sure, it's [PII]. There's no extension. It is an inbound line.
[AGENT][NEUTRAL] OK thank you and then what is [PII]'s policy number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] That's gonna be 02123377 M for Mike L for Lima 8.
[AGENT][NEUTRAL] 8. OK, I'm going to pull in that policy so I can give you eligibility and benefits. It's gonna be just a second.
[AGENT][NEUTRAL] OK, I do show Ms. [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her coverage. It's not a guarantee of payment. She has a supplemental insurance policy that is billed secondary to the primary. It's a gap insurance that helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She has an inpatient benefit amount of $6000 per calendar year and she also has an outpatient benefit amount of $2000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need me to check to see if she's used?
[CUSTOMER][NEUTRAL] OK, and that was for inpatient you say that?
[AGENT][NEUTRAL] Yeah, do you want me to check to see if she's used anything for [PII] yet?
[CUSTOMER][NEUTRAL] Uh, well, the benefits would not be for inpatients, so is the services only for inpatient.
[AGENT][NEUTRAL] No, it's, she has an outpatient.
[CUSTOMER][NEUTRAL] Um, oh, I'm sorry, the benefits.
[AGENT][NEUTRAL] Yeah, she has an outpatient benefit of $2000 per calendar year to help towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you. OK, got you. And yes, could you please check to see if anything's been applied to it?
[AGENT][POSITIVE] Yes, absolutely.
[AGENT][NEUTRAL] OK, nothing has been used this far this year thus far.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I got my words tangled up, sorry.
[CUSTOMER][NEUTRAL] OK. All right, thank you. And um and you said this is a supplement plan, so the supplement plan will only work with a traditional Medicare, is that correct? Or would you work with any other policies?
[AGENT][NEUTRAL] Uh, it works with her, um, primary insurance, whoever her primary insurance is, yeah.
[CUSTOMER][NEUTRAL] Whichever, OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, got you. All right, thank you for that.
[AGENT][NEUTRAL] So like when, so when the claim is sent in, it needs to have the EOB from the primary insurance and what they paid with it.
[CUSTOMER][NEUTRAL] OK, OK, and I have a claims mailing address as [PII], that's in [PII] City, Ok [PII].
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK, and is there a group number for billing purposes?
[AGENT][POSITIVE] Yes ma'am, let me look that group number up for you real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is 25037.
[CUSTOMER][POSITIVE] Thank you. And I have the plan name as Metlink.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and is there a employer or group name?
[AGENT][NEUTRAL] Uh yes, ma'am. Let me look real quick.
[AGENT][NEUTRAL] It is Oriente Latin America.
[CUSTOMER][NEUTRAL] All right. Thank you for that. And uh so just to go over, um, for whatever benefits, uh, you will cover, uh, the deductible and co-insurance up to $2000. And as of right now, nothing has been applied to it. Did I get that information correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Alright, thank you. Alright, and uh you will coordinate with the primary payer, um, so if the primary payer denies you would deny as well, correct? Or would you still consider these two? OK, got you. Alright, alright. And is there a reference number for our call?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] Alright, thank you so much, [PII]. I hope you have a great day.
[AGENT][POSITIVE] You too, Ms. [PII], you have a blessed one. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.