AccountId: 011433970860
ContactId: 7c04031c-7d0f-4931-9ddb-091cef62cda3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283480 ms
Total Talk Time (AGENT): 141102 ms
Total Talk Time (CUSTOMER): 86713 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/7c04031c-7d0f-4931-9ddb-091cef62cda3_20250227T13:57_UTC.wav
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[AGENT][NEUTRAL] Contacting APO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII] calling from provider offers for eligibility and benefits of a patient.
[AGENT][NEUTRAL] I can help with eligibility and benefits, and what is the policy number please that we're looking at?
[CUSTOMER][NEUTRAL] Um, it is 01822969.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, just give me a second. Patient's name is [PII] please and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] So the callback number is [PII].
[AGENT][NEUTRAL] Thank you. Um, this is Group Gap Insurance, and each time they renew as a group, they get a new policy number.
[AGENT][NEUTRAL] And so that new policy number that went into effect on [PII].
[AGENT][NEUTRAL] It's 02
[AGENT][NEUTRAL] 56
[AGENT][NEUTRAL] 432 8. Now that went into effect on [PII]. It is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy, you mentioned benefits. The policy has both in and out of hospital benefits. Um, what we do is we pick up the deductible, co-payment or co-insurance from your major medical. Is there any particular type of benefit? Is this for inpatient, outpatients? Um,
[CUSTOMER][NEUTRAL] Um, it is for the outpatient and CPAP supplies.
[AGENT][NEUTRAL] OK, so for durable medical, uh, policy, or excuse me for supplies, what we will do, um.
[AGENT][NEUTRAL] What we will do is we will pick up the deductible, co-payment, or co-insurance.
[AGENT][NEUTRAL] Up to $7350 per calendar year. That is just a verification of the benefits, not a guarantee of payment, um, that is per individual.
[AGENT][NEUTRAL] And so for those uh supplies, you would file through their major medical first and and then to, to us, but that is what we will do to pick, that's the amount of money that we'll pick up.
[CUSTOMER][NEUTRAL] OK. And your secondary right, and there is no network for this policy, right?
[AGENT][NEUTRAL] That is right. Yes. What we do is we follow the major medical. So if you're in network with them and there's a deductible, co-payment or co-insurance, and that is what we do, that's what we pay.
[CUSTOMER][NEUTRAL] OK. Just give me a minute.
[CUSTOMER][NEUTRAL] And your network status will be there is no network, in and out of network pays the same, right?
[AGENT][NEUTRAL] Out of network does not pay, no. If, if the major medical, if you're not in network with a major medical and there's no deductible, co-payment or co-insurance, then you cannot file through us.
[CUSTOMER][NEUTRAL] OK. And may I know the primary insurance for this member, please?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] I'm checking that we're showing it as United Health.
[CUSTOMER][NEUTRAL] OK. And just give me a minute.
[CUSTOMER][NEUTRAL] And there, there is no deductible for this policy, right? Only DME maximum is there, right?
[AGENT][NEUTRAL] Right, I don't, I don't show a deduct.
[CUSTOMER][POSITIVE] OK. Thank you for that.
[CUSTOMER][NEUTRAL] And policy cover fully, right? There is no coinsurance deductible and nothing on the policy, only the maximum amount of $7350 right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] And may I have the call reference number for this patient, please?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII].
[AGENT][NEUTRAL] We're gonna use that today's date as a reference.
[CUSTOMER][NEUTRAL] And just, may I have the claim mailing address to submit the claims?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Our zip code is [PII], [PII].
[CUSTOMER][POSITIVE] OK. Thank you for that. Thank you for your assistance, [PII]. Have a great day and stay safe and bye for now.
[AGENT][POSITIVE] Thank you for contacting AP have a good day.