AccountId: 011433970860
ContactId: 8359c846-4a8f-4f69-8bd5-18849b35b0a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308119 ms
Total Talk Time (AGENT): 97272 ms
Total Talk Time (CUSTOMER): 147365 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/8359c846-4a8f-4f69-8bd5-18849b35b0a9_20250306T14:52_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, good morning, [PII]. This is [PII] Last name initial is [PII]. I'm calling from AAT Diabetic.
[CUSTOMER][NEUTRAL] And I just wanna check benefits and eligibility for this number and possibly check the billing history of the procedure, uh sorry, procedure codes.
[AGENT][NEUTRAL] What is your callback number, [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, that's [PII], no extension.
[AGENT][NEUTRAL] What is your policy number?
[CUSTOMER][NEUTRAL] Um, I got two different ones here. I got D for Delta 43731637.
[AGENT][NEUTRAL] What is the other policy number?
[CUSTOMER][NEUTRAL] Um, the other policy number that I have is um 02537810.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, yeah, that's for [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, I have that number pulled up. Thank you so much for that verification process. Um, you're calling for eligibility benefits and I'm sorry, what was the third request?
[CUSTOMER][NEUTRAL] Um, checking if this procedure code was already been billed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, this policy shows effective as of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And shows this active and what benefit would this be for office visit?
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um, this is for outpatient home, uh, for DME. I have codes here actually if you want. Um, I need, yeah, this is for DME, but I need the billing history as well for these codes. These are CPAP supplies.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, this is a limited indemnity policy. It does not cover DME again it does not cover DME.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So there's no DME coverage for this number.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] And I'm sorry, you mentioned this is an indemnity plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So this is uh indemnity, not a PPO or HMO plan. So this is like a fee for service, right?
[AGENT][NEUTRAL] We pay specific services, uh, fees for specific, yes, services.
[CUSTOMER][NEUTRAL] So just for, um, but the plan itself is uh uh uh it's a fee for service, right? Or it's indemnity alone?
[AGENT][NEUTRAL] This is a limited indemnity policy.
[CUSTOMER][NEUTRAL] Indemnity policy and the plan type is indemnity as well, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That is correct, [PII].
[CUSTOMER][POSITIVE] I see no problem. And also there's no out of network uh benefits as well for this, right?
[AGENT][NEUTRAL] This does participate in multi plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And sorry, just for the eligibility, uh, you mentioned that this plan started [PII]. Can we also make sure this is the primary insurance of the member because I think this is like a uh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Commercial plans, so.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Correct, um, we do not coordinate benefits, so I'm not certain if that member has another insurance or not. Again, we do not coordinate benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You don't coordinate benefits I see no problem.
[CUSTOMER][NEUTRAL] So this will follow your own guidelines technically, right?
[AGENT][NEUTRAL] It will follow the guidelines of the policy and it does not cover DME. This is a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] I see and what's the plan name or the product name for this?
[AGENT][NEUTRAL] It's hospital indemnity.
[CUSTOMER][NEUTRAL] Hospital indemnity.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I see, no problem, let me, uh, note it down here.
[CUSTOMER][NEUTRAL] And I'm sorry uh what's the group number just for documentation?
[AGENT][NEUTRAL] Of course, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The group number shows 70056.
[CUSTOMER][NEUTRAL] 70056. I see. That's perfect. Thank you for that. And yeah, again, for this services, um, this will not be covered since the uh
[CUSTOMER][NEUTRAL] Uh, members plan does not have any DME coverage, right?
[AGENT][NEUTRAL] That is correct. No DM me coverage.
[CUSTOMER][POSITIVE] No problem, um, I'll be good with that and sorry uh again your name is [PII], right?
[AGENT][NEUTRAL] That is correct. My name is [PII]. Last initial is [PII], and [PII], we do not provide reference numbers, but you can use my name in today's date. Last initials [PII].
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] Today's date in my name.
[CUSTOMER][POSITIVE] That's perfect. Thank you for that, [PII], and thank you for checking this number for me. Enjoy the rest of your shift. You have a good one.
[AGENT][NEUTRAL] Oh my God.
[AGENT][POSITIVE] And thank you for calling APL [PII]. You have a great day as well. Take care bye bye.
[CUSTOMER][POSITIVE] Thank you, yep, you take care as well.
[AGENT][NEUTRAL] Bye.