AccountId: 011433970860
ContactId: 84099916-fbed-45ef-b75c-bcbaf383bc71
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 816799 ms
Total Talk Time (AGENT): 341371 ms
Total Talk Time (CUSTOMER): 311365 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/84099916-fbed-45ef-b75c-bcbaf383bc71_20250224T19:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. That's [PII] initial of my last name is [PII]. I'm on a recorded line calling because we have a patient coming into the office for infusion therapy, and I just need to verify their benefits and eligibility for a few procedure codes, please.
[AGENT][NEUTRAL] OK, right, so you're wanting to verify eligibility and benefits for a member coming into the office for procedure. Is that correct?
[CUSTOMER][NEUTRAL] Yep, yep, that's it.
[AGENT][NEUTRAL] Yes, sir, I can help you with this. And so [PII], what is your callback number first off?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Policy number is 02556241.
[AGENT][NEUTRAL] OK, thank you one moment while I get all the members information pulled up please.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, [PII] any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient is [PII] and birthday is [PII].
[AGENT][NEUTRAL] Uh-huh
[AGENT][NEUTRAL] OK, thank you. So she is the subscriber on the supplemental policy. This is a supplemental policy to her primary insurance and this policy is effective.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And on the supplemental policy, she does have an office treatment writer. Of visits are not covered, but she has the treatment writer in which we can review.
[AGENT][NEUTRAL] Under for covered outpatient services under her outpatient benefits and that benefit max for outpatient is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, $8150 per calendar year per covered person again for covered outpatient services and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] So when the claim is submitted to APL for review price we will also need for you to send the a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well
[AGENT][NEUTRAL] And then once we have processed the claim here at APL, we also have a portal that you can check claim status for us and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] [PII]. Awesome.
[AGENT][POSITIVE] Uh-huh, that is correct. Yes, sir.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, do you, uh, take procedure codes to check the benefits for those and if authorizations required?
[AGENT][NEUTRAL] No, sir, because this.
[AGENT][NEUTRAL] There would be no authorization on the supplemental policy. It would follow her primary insurance. So anything not covered by primary would also not be covered by this policy.
[AGENT][NEUTRAL] This is only a supplement to help her with her co-pays, deductibles and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So the $8150 the total limit, how do they reach that if there's no deductible?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, that's why we have to have a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] Because if it's a covered service and they have applied anything to those three areas, this policy helps them with that up to that benefit max.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] OK. So.
[CUSTOMER][NEUTRAL] So you all just pick up anything from the primary insurance?
[AGENT][NEUTRAL] Not anything. Not anything. Well, that's why we, uh, we have to receive your claim along with the primary EOB.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let's see
[CUSTOMER][NEUTRAL] Um, just trying to make sure I get this down right. So, like, um, so this insurance by itself doesn't have any benefits, it's just covering.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] In addition to what the, OK.
[AGENT][NEUTRAL] Yes, we are not a major medical insurance company.
[AGENT][NEUTRAL] This is only a supplemental policy to her primary insurance.
[CUSTOMER][NEUTRAL] OK, just writing all that down.
[AGENT][NEUTRAL] And as of now, as of now she has used excuse me, $2,475.34 of her calendar year max.
[AGENT][NEUTRAL] As of now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And 24.
[CUSTOMER][NEUTRAL] Oops.
[CUSTOMER][NEUTRAL] Oh, not 247,000, 2000.
[AGENT][NEUTRAL] That would be a lot, but yeah, it's not saying it's not, but no.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] $2,475.34.
[AGENT][NEUTRAL] Has been used as of now.
[CUSTOMER][NEUTRAL] 34 cents, yes.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So for.
[CUSTOMER][NEUTRAL] And authorization would not be required. All right.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, uh, if the provider was wondering if they could buy and build, would that just be up to the primary insurance?
[AGENT][NEGATIVE] There, yes, because there are no uh benefits for medication on this policy.
[CUSTOMER][NEUTRAL] Exclusion list with follow primary insurance, got you.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, let's see, uh.
[CUSTOMER][NEUTRAL] The specialty pharmacy that also follow the primary insurance?
[AGENT][NEGATIVE] Uh, yes, again, on this supplemental policy, there are no benefits for medication.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Primary.
[CUSTOMER][NEUTRAL] OK, and secondary.
[CUSTOMER][NEUTRAL] Um, so I got the effective date of [PII]. Uh, does the plan, does the plan run on a plan year around that, or is it on a calendar year? Got you.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] The calendar year.
[AGENT][NEUTRAL] The calendar year plan. Mhm.
[AGENT][NEUTRAL] That's just the effective date.
[CUSTOMER][NEUTRAL] Um, let's see.
[AGENT][POSITIVE] That her policy became effective.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Not really sure how many of these questions apply, so, uh, kind of just bear with me for a few seconds. This is some eligibility kind of stuff. Is the policy self-funded or fully funded?
[AGENT][NEUTRAL] This is an employer pay plan.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] You guys would not require any kind of referrals, I'm guessing?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So this is their uh supplemental insurance, um, would that just be the, the policy type or I guess, um,
[AGENT][NEUTRAL] Only.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Well, this wouldn't be a PPO policy because it's the secondary I'm guessing so it would just be the.
[AGENT][NEUTRAL] No, it's, that's correct. It's only a supplement. Like I said, we're not a major medical carrier, so there's no like plan type, you know, like H or there's none of that.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] This is a supplemental med link policy, like a gap policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] All right. Um, do you guys have any kind of group name or group number?
[AGENT][NEUTRAL] The group number is 22517.
[AGENT][NEUTRAL] And her employer name is Growing Green Inc.
[CUSTOMER][POSITIVE] Green ink. Awesome.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, that there.
[CUSTOMER][NEUTRAL] And then finally, uh, would you guys have your own mailing address for claims or would it just be the same as the primary insurance?
[AGENT][NEUTRAL] No, sir, it's the same address as on that's on her ID card.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Do you have a copy of that?
[CUSTOMER][NEUTRAL] Um, I do not in front of me, I think that.
[AGENT][NEUTRAL] So APRs
[CUSTOMER][NEUTRAL] No, this is a brand new patient.
[AGENT][NEUTRAL] APO's card, I mean mailing address for claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then I think I already gave this to you guys, but once we have processed the claim, we do have, we talked about a lot, so I'm not sure if I gave it to you yet or not. So if, if I did just forgive me, but we have a portal that you should be able to check claim status for APO once we've processed the claim and our portal website that you would go to is secured.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right. Got that. And I think that's actually all of my questions for this one, and we did get a lot of it. So just gonna read back through it and make sure I got this all right. So, [PII] coming in, this is our secondary insurance, so a lot of this is going to be following the primary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, this insurance does not have any specific benefits itself. It is just an $8150 calendar out of pocket limit. So far, $2,475.34 has been met. Authorization is not required for you all. Um, there's no buy and bill, any kind of carveout list or specialty pharmacy, all that's gonna follow the primary insurance.
[CUSTOMER][NEUTRAL] Uh, let's see. Policy goes on a calendar year. It is through the employer does not need any sort of referrals, got the group name, got the group number, got the claims address, we got the online portal. I think we just got about everything. Um, does all of that sound right to you, [PII]?
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Yes, this policy again is a supplemental only that helps with co-pays, deductibles and co-insurance amounts of covered services and just make sure that when you file a claim with APL that you also send the details.
[AGENT][NEUTRAL] Primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, and I think the only thing left is can I get a reference number for the call before I go?
[AGENT][NEUTRAL] Sure. You would use my name, [PII], along with today's date and if you need the first initial to my last name, it is [PII].
[CUSTOMER][POSITIVE] All right, [PII]. Thank you so much for all your help today. I really appreciate it.
[AGENT][POSITIVE] OK, well, you are certainly welcome. It was my pleasure. Absolutely it was my pleasure, [PII]. So if that's all I can help you with, thank you again for calling APL, and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you. You as well. Goodbye.
[AGENT][POSITIVE] Yes, sir. Thank you too. Bye bye.