AccountId: 011433970860
ContactId: 81aa8f83-982f-4034-92bf-32c442a0cb9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403260 ms
Total Talk Time (AGENT): 133676 ms
Total Talk Time (CUSTOMER): 143733 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/81aa8f83-982f-4034-92bf-32c442a0cb9e_20250613T20:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and can you please help me check member eligibility and benefits?
[AGENT][POSITIVE] Yeah, I'm happy to check on eligibility and benefits. Do we have a policy number?
[CUSTOMER][NEUTRAL] Uh yes. 02545746.
[AGENT][NEUTRAL] Thank you. And what's the insured's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So, patient is active. The effective date on here is gonna be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We're the members secondary insurance, so this is gonna cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] Uh, so this is a true secondary, not the supplemental plan.
[AGENT][NEUTRAL] It is a secondary supplemental plan, yes.
[CUSTOMER][NEUTRAL] secondary Sumano. Does this follow Medicare guidelines or no?
[AGENT][NEGATIVE] No, it does not. There is no coordination of benefits on it or anything.
[CUSTOMER][NEUTRAL] Uh, OK, so this will pick up whatever is left by the primary up to the allowed amount, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, and is there like um in network or out of network or no?
[AGENT][NEUTRAL] There's no network required for usage. There is an inpatient outpatient benefit max. Would you like those amounts?
[CUSTOMER][NEUTRAL] Yeah, please. Uh what is that, what is that called?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Like a threshold.
[AGENT][NEUTRAL] Mhm, so their outpatient benefit max for the calendar year is gonna be 2500.
[AGENT][NEUTRAL] It'll pay for outpatient services up to up to 2500.
[CUSTOMER][NEUTRAL] And how much
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] OK, because this is actually for outpatient physical therapy done in the office office setting, so there is um maximum, what is that called? Outpatient maximum.
[CUSTOMER][POSITIVE] Um, bene benefit.
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] The max is
[CUSTOMER][NEUTRAL] So that's up to 25.
[AGENT][NEUTRAL] Mhm. 2500.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 2500. And how much so far is the accumulation?
[AGENT][NEUTRAL] $250.
[CUSTOMER][NEUTRAL] $250 as of now. OK. And visit limit, is there a visit limitation or just based on medical necessity?
[AGENT][NEUTRAL] Uh, no, no limitation on visits. Let me just, you said the patient's being seen for physical therapy?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Let me see if that's a covered.
[AGENT][NEUTRAL] OK, yeah, there is no limitation as far as visits, it's just the dollar amount of $2500.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Alright and no requirements like referrals or orders or authorizations?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Let me see, no referrals, no authorization.
[CUSTOMER][NEUTRAL] And what's the name of this plan? Is this like um like a PPO, POS, HMO?
[AGENT][NEUTRAL] It's a Medlink plan. It's spelled M as in Mary, E as in Edward, D as in Delta, L as in Lima, I as in India.
[AGENT][NEUTRAL] N as in November, K as in Kilo.
[CUSTOMER][NEUTRAL] That's one word right Medlink.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, no uh no requirements, no network status. And yeah, I think that's pretty much it. Um, where can we submit the claims?
[AGENT][NEUTRAL] Claims can be submitted electronically via mail or fax. I can give you all three or just whatever you need.
[CUSTOMER][POSITIVE] Yeah, I'll get those 3, please.
[AGENT][NEUTRAL] So the payer ID is gonna be 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The fax number is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And then the claims mailing address?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, um, I think that's all. This is secondary. I think that's all that I need. Thank you, [PII]. Um, can I have the initial of your last name and then the call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Initial to my last name is [PII].
[AGENT][NEUTRAL] Call reference is my name with today's date.
[CUSTOMER][NEUTRAL] OK. And by the way, sir, I forgot to confirm the effective date is [PII], right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] OK. All right, that's all, thank you.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] You too bye bye.