AccountId: 011433970860
ContactId: 81f16314-ae55-4b4b-87dc-ca1b41fd2f5d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366089 ms
Total Talk Time (AGENT): 116040 ms
Total Talk Time (CUSTOMER): 112237 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/81f16314-ae55-4b4b-87dc-ca1b41fd2f5d_20250605T20:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], calling on behalf of the Amgen Support Plus program on a recorded line for training and quality assurance. I'm calling to verify medical benefits for patient [PII], who is a mutual patient of Dr. [PII].
[AGENT][NEUTRAL] Yes, ma'am. Could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] My direct callback number is [PII]. No extension is required.
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] The patient's ID number is 01936871.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's first name, [PII], spelled [PII], last name [PII] spelled [PII] Patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Do you need to verify benefits or check on the status of the claim?
[CUSTOMER][NEUTRAL] I'm calling to verify a network benefits for an injection of Prolia with procedure code J0897. The administration code is 96372, and the diagnosis code is M81.0 administered in a specialist office. First, could you spell out your first name and provide the initial of your last name, please?
[AGENT][NEUTRAL] Um, my name is spelled [PII] is my last initial.
[CUSTOMER][NEUTRAL] What is the policy effective date?
[AGENT][NEUTRAL] OK, the effective date on this policy was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] What is the plan name?
[AGENT][NEUTRAL] Medlink, [PII]
[CUSTOMER][NEUTRAL] What type of plan is this?
[AGENT][NEUTRAL] Gap insurance?
[CUSTOMER][NEUTRAL] Is it a PPO, POS, or HMO plan?
[AGENT][NEUTRAL] It's Gap Insurance, GAP supplemental.
[CUSTOMER][NEUTRAL] Is there a standard plan letter for this patient's supplemental plan?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] And it covers up to 4000 per calendar.
[CUSTOMER][NEUTRAL] For billing purposes, what is the group number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group number is.
[AGENT][NEUTRAL] 12696.
[CUSTOMER][NEUTRAL] What is the
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] What is the group name?
[AGENT][NEUTRAL] City of Electra.
[CUSTOMER][NEUTRAL] What is the individual deductible for this plan and how much has been met?
[AGENT][NEUTRAL] There's no deductible for this plan.
[CUSTOMER][NEUTRAL] What is the individual out of pocket maximum and how much has been met?
[AGENT][NEUTRAL] For outpatient services, we cover up to 4000 per calendar year for the coinsurance and the deductible, but the co-pay for the office visit is not covered.
[AGENT][NEUTRAL] And so far, let's see.
[AGENT][NEUTRAL] So far, $1,383.21 have been met.
[CUSTOMER][NEUTRAL] Just to confirm,
[CUSTOMER][NEUTRAL] What is the individual out of pocket maximum and how much has been met?
[AGENT][NEUTRAL] The out of pocket maximum is.
[AGENT][NEUTRAL] $4000 per calendar year and so far $1,383.21 have been met.
[CUSTOMER][POSITIVE] OK, great. Thanks. Just a moment, please.
[CUSTOMER][NEUTRAL] What is the claim's mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code [PII].
[CUSTOMER][NEUTRAL] Can I have a reference number, please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. That's [PII]
[AGENT][NEUTRAL] 65 2025. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] One last question, how was your experience today chatting with me?
[AGENT][NEUTRAL] A little different, but
[AGENT][POSITIVE] I can do it.
[CUSTOMER][POSITIVE] Appreciate the kind words. Thanks so much for your help today. Have a great day. Bye.
[AGENT][NEUTRAL] Bye [PII]. Thank you for calling ATL.