AccountId: 011433970860
ContactId: 771685c7-9bba-4687-aafe-c5c5ae3f11e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281500 ms
Total Talk Time (AGENT): 112619 ms
Total Talk Time (CUSTOMER): 134183 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/771685c7-9bba-4687-aafe-c5c5ae3f11e9_20250425T19:11_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi. So my name is [PII]. I'm calling from a DME provider's office to verify some benefits, um, information for one of your members.
[AGENT][POSITIVE] OK, sure. I can assist you with the benefits from for the I mean [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm. [PII] it's my direct line.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02456843.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] All right, um let's see.
[AGENT][NEUTRAL] Before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And um we have an outpatient maximum of $2400 per covered person per calendar year after a $100 deductible. This includes DME. Now the DME does not include um
[AGENT][NEUTRAL] Disposable supplies.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] In this case, this is his secondary insurance?
[AGENT][NEUTRAL] It is. Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. OK. From that $100 deductible, is there any accumulation so far?
[AGENT][NEUTRAL] I can check. Let's see.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] As of today, he has not used his benefit or met any of his deductibles.
[CUSTOMER][NEUTRAL] So nothing. OK. That um 2400 that you mentioned, that's like the limit for DME or that's like an out of pocket amount?
[AGENT][NEUTRAL] That is the limit for any outpatient service including DME. So this policy is set up to help with the deductibles, co-payment, and coinsurance from the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Co-pay. OK. So, um, once the patient meet that $100 deductible, this policy will be able or will pick up any remaining, any co-pay, deductible or co-insurance from the primary?
[AGENT][POSITIVE] Correct, up to the amount of 2400. Mhm. Correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Up to the amount, is that OK, OK, OK, I see. um, so right now that he has sent me anything, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You will not cover anything until he meets that $100.
[AGENT][NEUTRAL] Correct. Um, he will, um, you can submit the claim so we can go ahead and apply that towards, um, the deductible, and then once we get enough to cover that deductible, then we'll start start paying from that 2500, 2400 sorry.
[CUSTOMER][NEUTRAL] OK, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Got it. What type of policy is this?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Oh, the supplemental plan. OK. I see. Um, is this, uh, is he the subscriber?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um, an authorization is gonna be, well, it's a supplement. I don't think so, but I need to ask, is, uh, uh, this policy need any reason? OK.
[AGENT][NEUTRAL] No. Mhm.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, and you will follow primary guidelines, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right. Thank you for that. I think I have no other questions regarding this policy. Thank you so much. Can you spell your name for me?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] If there's a reference number for the call, sir?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like.
[CUSTOMER][POSITIVE] All right. Thank you so much again for your help and your time. I appreciate it. Have a wonderful rest of the day. Enjoy your weekend.
[AGENT][POSITIVE] You as well thank you for calling ATL. Bye bye Miss [PII].
[CUSTOMER][POSITIVE] Thank you. Mm bye.