AccountId: 011433970860
ContactId: 81dc140f-13b6-4189-823c-dad85c67741a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351369 ms
Total Talk Time (AGENT): 188739 ms
Total Talk Time (CUSTOMER): 131282 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/81dc140f-13b6-4189-823c-dad85c67741a_20250113T15:08_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with ASI patient support on behalf of Doctor [PII]'s office. I was trying to get benefits and eligibility for one of your members, please.
[AGENT][POSITIVE] Sure, I can assist you with benefits and eligibility, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, can I get your, I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] Oh, sure. My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Alright, so my um call back is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, perfect. Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02502 I'm sorry 3244.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] date of birth would be [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. And you said that you need eligibility and benefits. The benefits is for an office visit or office procedure or both?
[CUSTOMER][NEUTRAL] So it would be for a J code and it's administration.
[AGENT][NEUTRAL] OK. All right. And 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. Um, we have an effective date of [PII]. It is active at the moment and this is one of our secondary supplemental plans to the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] And we have.
[CUSTOMER][NEUTRAL] So it'd be secondary to Medicare or to the commercial plan that the patient has on file?
[AGENT][NEUTRAL] The commercial plan.
[CUSTOMER][NEUTRAL] OK, secondary.
[AGENT][NEUTRAL] To any major medical. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And it looks like the outpatient maximum is 1500 per covered person per calendar year, and this includes the office treatment. It does not include the office visit. We do not cover the office visit. It's just gonna be for treatment or procedures.
[CUSTOMER][NEUTRAL] OK, so I'm, I'm trying to understand there's a $1500 can you, can you repeat that? I'm sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, there's a calendar year maximum of 1500 for outpatient service, including office treatments or procedures.
[CUSTOMER][NEUTRAL] OK, so you guys will only cover 5 $1500 a year.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] For our patient service mhm.
[CUSTOMER][NEUTRAL] OK, and would that be for, what about for the J codes?
[AGENT][NEUTRAL] Yeah, that is uh treatment or procedures. Those are procedures done in the office, so those are considered under that benefit.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, the only thing we do not cover again is like the co-payment for the visit itself like if, if there's a 9921499218, yeah, those are not covered, but if it's any procedures done in the office, yes, those those are considered.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and if those costs go over $1500 a year, then the patient would be responsible for the remainder?
[AGENT][NEUTRAL] Correct. If it's higher than 1500 per year, anything over its members responsibility.
[CUSTOMER][NEUTRAL] OK perfect and so this would be a medic or it would be a supplement plan is there like a is it like a
[CUSTOMER][NEUTRAL] Is there a letter on it or just supplement?
[AGENT][NEUTRAL] It's just a supplement because it's not um it's not a Medicare or Medicaid supplement. It's just a, a major medical supplement. So it's to any major medical like Blue Cross, Cigna, United Healthcare is um basically a secondary to help with the high deductible co-payment and co-insurance.
[CUSTOMER][NEUTRAL] OK perfect and um what is your claim's address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, give me just one second here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That is [PII] Ok [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that is correct, yes. Mhm.
[CUSTOMER][NEUTRAL] And is there like in and out of network benefits or it doesn't matter?
[AGENT][NEUTRAL] We follow primary, so there's no in or out of network. There's no networks.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Alright, alright, well I think that answers all my que do you guys allow for buying bill?
[AGENT][NEUTRAL] Um, for buying bill, no, we don't do any pharmaceuticals, but what we only pay the administration.
[CUSTOMER][NEUTRAL] Just the administration so the J code would not be covered.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] The code is the administration.
[CUSTOMER][NEUTRAL] The because because the no the J code is for the medication Lakimbi. It's built under the medical benefits.
[AGENT][NEUTRAL] OK. Usually a J code is covered. Any J codes or any administration codes are covered.
[CUSTOMER][NEUTRAL] OK, OK, I understand. Alright, alright, um, so I think that answers all my questions. Do you have a reference number for today's call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] You said [PII], right?
[AGENT][NEUTRAL] Yes, [PII] last initial [PII]
[CUSTOMER][POSITIVE] And it's [PII]. OK, alright, so thank you for taking the time to speak with me and as I quote patience support. Have a wonderful rest of the week.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Yeah it's OK. You as well, Mr. [PII]. Thank you for calling APR. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.