AccountId: 011433970860
ContactId: 7dc009c5-99c5-400e-b335-fd5c29581a5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267339 ms
Total Talk Time (AGENT): 133771 ms
Total Talk Time (CUSTOMER): 111013 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/7dc009c5-99c5-400e-b335-fd5c29581a5a_20250109T20:43_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] calling from provider's office and the spelling is [PII]. And my last initial is [PII] for [PII]. I'm looking for DME benefits and also authorization requirements for a member.
[AGENT][POSITIVE] All right, it would be a pleasure to assist you with DMA benefits and authorization. What is the callback number, please?
[CUSTOMER][NEUTRAL] And the callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, the insurance ID is 02574215.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Member's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. It would be a pleasure to assist you with DME benefits for [PII]. I am showing that her policy is active.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] Now this is a limited hospital indemnity policy and DME is not a covered benefit under her plan.
[CUSTOMER][NEUTRAL] Got it and um may I know the plan type?
[AGENT][NEUTRAL] It is a limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Is there any other name for this, uh, like HMO, PPO, POS like that?
[AGENT][NEUTRAL] No, sir, it's an indemnity policy.
[CUSTOMER][NEUTRAL] Uh, could you spell for me for that?
[AGENT][NEUTRAL] I can it's I as in India, N as in November, D as in Delta, E as in Echo, M as in Mike.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] I as in India. T as in Tango. Y as in Yankee.
[CUSTOMER][NEUTRAL] OK, got it. Thanks for the spelling. And, uh, uh, this insurance is the primary insurance to the members plan.
[AGENT][NEUTRAL] No, sir, this is a standalone policy. It is not a secondary gap policy.
[CUSTOMER][NEUTRAL] OK, may I know the group number for billing purpose?
[AGENT][POSITIVE] Yes sir, uh that I can get that group number for you.
[AGENT][NEUTRAL] Group number is 70083.
[CUSTOMER][NEUTRAL] OK, and uh may I know the deductible and the maximum amount of pocket for this member?
[AGENT][NEUTRAL] There's no deductible, co-pay or co-insurance on this plan. So there's no out of pocket, we just pay the benefit amount.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] For the covered services.
[CUSTOMER][NEUTRAL] That means it will.
[CUSTOMER][NEUTRAL] Uh, it will act like a Medicaid plan, is that correct?
[AGENT][NEUTRAL] No, sir. It's just, it's not a Medicaid plan. It's just a sec uh.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] Another policy
[CUSTOMER][NEUTRAL] You know, I'm, I'm.
[CUSTOMER][NEUTRAL] Uh, I'm just asking it for, uh, there is no deductible and there is no out of pocket, and it shows that there is no coinsurance to that means the plan is covering 100%. So is that correct?
[AGENT][NEUTRAL] It's just an additional cost.
[AGENT][NEGATIVE] Well, the DME is not covered, and I can't compare it to any other insurance. It's just a limited indemnity policy. There's no out of pocket on this plan.
[CUSTOMER][NEUTRAL] I got it. Uh, uh, OK. And may I know the operation is required or not required. I'm among the CPT codes.
[AGENT][NEUTRAL] It is not required on this plan.
[CUSTOMER][NEUTRAL] Uh, OK, got it. OK, that's it. Uh, please spell your name and the call reference number.
[AGENT][NEUTRAL] The call reference number is my name and today's date, and I spell my name [PII]
[AGENT][NEUTRAL] First initial and my last name is [PII].
[AGENT][POSITIVE] And wait, it was a pleasure to assist you with that um benefit for the patient. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's it. Thanks. Thanks for that confirmation and have a nice day.
[AGENT][POSITIVE] And I hope you have a nice day as well. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah bye bye.