AccountId: 011433970860
ContactId: 84f9c445-9cfb-4198-860e-56ab62b969b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 883010 ms
Total Talk Time (AGENT): 344744 ms
Total Talk Time (CUSTOMER): 327191 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/84f9c445-9cfb-4198-860e-56ab62b969b0_20241230T16:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm the administrator for Home Comfort Enterprise. I just got off the phone with one of your representatives over there and one of my guys is debating whether he wants to sign up for.
[CUSTOMER][NEUTRAL] Y'all's coverage.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he is going to be having a sleep study done.
[CUSTOMER][POSITIVE] They're giving him the equipment and he's going home to do it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I need to know whether that's covered and then if they say that he needs the durable medical goods, does that go towards his deductible or not?
[AGENT][NEUTRAL] Deductible. OK.
[CUSTOMER][NEUTRAL] I know, I'm sorry, lots of questions, not a lot of answers.
[AGENT][NEUTRAL] No, that's fine. Um, [PII], may I have a good contact number in case we're disconnected, so, and then I'll make sure I repeat it back so I understand.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Our group number is 18735.
[AGENT][NEUTRAL] So you need to know if sleep studies are covered, if the DME is gonna go towards the deductible?
[CUSTOMER][NEUTRAL] Yeah, I mean, because they have a $1000 deductible.
[CUSTOMER][NEUTRAL] So they are giving him the equipment to take home to do the study.
[AGENT][NEUTRAL] OK, hold on one moment, let me pull your group up first. Hold on one second.
[CUSTOMER][NEUTRAL] Oh my god.
[CUSTOMER][NEUTRAL] I can't tell who's handwriting this is.
[CUSTOMER][NEUTRAL] I I love when my guy signed shit and I can't even read it.
[AGENT][NEUTRAL] Oh Lord.
[CUSTOMER][NEGATIVE] Oh yeah, I mean, it's like such chicken stretch, it's like stupid.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] 26th
[AGENT][NEUTRAL] So I have the group here. I just need you to, well, hold on one second. You said you just spoke with someone, right?
[CUSTOMER][NEUTRAL] Yeah, I mean, I just spoke with somebody.
[AGENT][NEUTRAL] OK, so we don't have to go through all that. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah, please, please, please give me a break. OK, 183, so he's on base, so negative 194.88.
[CUSTOMER][POSITIVE] And vision stays the same, OK.
[CUSTOMER][POSITIVE] Safe class.
[CUSTOMER][NEUTRAL] I'm assuming that [PII] is staying the same, he dropped that delete.
[CUSTOMER][NEGATIVE] Going tray, I don't even have any shit.
[AGENT][NEUTRAL] OK, hold on one moment, [PII], OK? I'm gonna pull up all the benefits so I can check on sleep study. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah please do because we're on that med link so I wanted to double check it before he signs up for it.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 41. You are on hold.
[AGENT][NEUTRAL] Who did you talk to?
[AGENT][NEUTRAL] Yeah and like.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Thank you for calling APL, this is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you?
[CUSTOMER][POSITIVE] Good how are you?
[AGENT][POSITIVE] I'm doing good. So, I have a question.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I, now I'm starting to second guess myself. OK, I have a group admin on the other line. She has a member that they that's trying to enroll or thinking about enrolling, but he has questions about their policy and the sleep study and DME and their deductible. I tried to find like the master on on base, but I don't see anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the group number? Did they give you the group number?
[AGENT][NEUTRAL] Um, it's 18735.
[CUSTOMER][NEUTRAL] Home Comfort Enterprises? OK.
[AGENT][NEUTRAL] Uh, we're talking to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But now, but when I was holding, then I started questioning, should I have called group billing or it is broker resources cause it's enrolling and stuff.
[CUSTOMER][NEUTRAL] Uh, what, mhm.
[CUSTOMER][NEUTRAL] Well, if they're asking about product information claims usually has to handle that, um, because, and they, they probably a lot of times won't answer because they don't have a policy issue, but I think they can ask, they can answer like generic information, um, that's what I would do because we if let's see, was there not a master policy is they're talking about the meddling policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, meddling 6.
[CUSTOMER][NEUTRAL] OK, OK, let me just look at something.
[CUSTOMER][NEUTRAL] I mean, I know you can click on one of those people that are insured into that group and pull up a policy, but I would, I would defer that to claims if they're talking about benefits, um, and how that works and see if they can help. If they don't wanna help send it back over, but really they're the ones that answer the benefit questions.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Well, thank you so much.
[CUSTOMER][POSITIVE] You're most welcome. Have a good day. Mm bye bye.
[AGENT][NEUTRAL] All right. You too. Bye-bye.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hey, thank you so much for holding. I apologize for that wait. So I was speaking with Broker Resources since there's not like an actual policy generated, so I can get the general benefits, um, but they're directing me to claims. So if, if you'll just hold on one moment, I'm going to get a claims representative so they can go through the product benefits for you to determine about the sleep study.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEGATIVE] Yeah, because you know our guy didn't have the time to call y'all who gave us our plan, so waste my day so sure pass me.
[AGENT][POSITIVE] Well, I'm definitely sorry about that, but I can, we're gonna get you to the right department so we can get it verified for sure for you, OK?
[CUSTOMER][NEUTRAL] I gotta get this done.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] E
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Bring
[CUSTOMER][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm good [PII], thanks for asking. How are you?
[AGENT][NEUTRAL] I'm doing good. Um, I have a group admin on the other line. They don't have, uh, so she has somebody that's trying to enroll into the benefits.
[AGENT][NEUTRAL] But they have a question about the sleep study. I guess if sleep study is not covered, he's not gonna get it, but their policy is not on base, so I called Broker Resources thinking, you know, enrollment, but they told me to call claims because it's about the product.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] So I'm just calling because.
[CUSTOMER][NEUTRAL] I don't even know.
[CUSTOMER][NEUTRAL] Mhm. Did they have a group number who they're affiliated with like, did, did you find a policy number with somebody on there or?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I mean, I could pull somebody, but I don't know.
[CUSTOMER][NEUTRAL] From that group? Is it from that group? What's the policy number?
[AGENT][NEUTRAL] Yeah, I can pull, mhm.
[AGENT][NEUTRAL] It's 18735.
[AGENT][NEUTRAL] So I just need to pull in, I just didn't, I can pull somebody and quote their benefit.
[CUSTOMER][NEUTRAL] What is that called? What is that screen for group? I, I didn't even have to do this.
[AGENT][NEUTRAL] G G R P I Q.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I'll be forgetting screens when I don't use them.
[AGENT][NEUTRAL] Well, it's a million, that's I know.
[CUSTOMER][NEUTRAL] It's 1585.
[AGENT][NEUTRAL] 18735.
[CUSTOMER][NEUTRAL] Why that group number was already in there. OK, so let me just click on somebody's name.
[CUSTOMER][NEUTRAL] Get a policy number.
[CUSTOMER][NEUTRAL] If it's considered as outpatient though, it will be covered if it's outpatient, sleep study outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But let me pull up the policy, see what type of policy they have.
[AGENT][POSITIVE] But if I, if I can just call anybody from the group, I can do that.
[CUSTOMER][NEGATIVE] Yeah, they got outpatient benefits, $1000 1000 dollars deductible though. So they're gonna be mad.
[AGENT][NEUTRAL] And she was asking if if he has to get durable medical equipment, does that go against the
[CUSTOMER][NEGATIVE] Uh, this then be not covered.
[AGENT][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] DME not covered under the policy. DME is not covered, durable medical equipment is not covered under the policy.
[AGENT][NEUTRAL] Wait, say that again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me pull up.
[CUSTOMER][NEUTRAL] Yeah, it covers the outpatient. So the sleep study would be covered if it's in an outpatient facility. But um
[CUSTOMER][NEGATIVE] The uh, the DMV is not covered. They don't have benefits for that or they don't have office visits.
[AGENT][NEUTRAL] Hold on, why is this not? OK, here it is. I'm just gonna pull up a policy.
[CUSTOMER][NEUTRAL] Let me give you the policy number 2156475. It's 2156475.
[AGENT][NEUTRAL] Hold on, my arm base is tripping. I can't, yeah, OK, it's uh, can you say that one more time? It just popped up.
[CUSTOMER][NEGATIVE] Is not on.
[CUSTOMER][NEUTRAL] 2156475.
[AGENT][NEUTRAL] I don't know what's going on with my sister, my lion, and my arm base just.
[AGENT][NEGATIVE] Tripping then.
[AGENT][MIXED] OK, $1000 deductible.
[AGENT][NEUTRAL] OK. I can quote that.
[CUSTOMER][POSITIVE] Alrighty, well call me if you need something.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][POSITIVE] You're welcome. Have a good one. Bye.
[AGENT][NEUTRAL] Bye bye. You too. Bye-bye.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, I got the answer for you. So again, all the information provided is a verification of benefits, not a guarantee of payment. So yes, the sleep study, um, once he takes everything back, it's going to be in an outpatient facility, right?
[CUSTOMER][NEUTRAL] No, he's doing it at home.
[AGENT][NEUTRAL] Right, right, he sleeps at home, but where is the testing being done?
[CUSTOMER][NEUTRAL] At his house. They're giving him the equipment and he's taking it home.
[AGENT][NEUTRAL] Right, but he has to give it back to who to test that.
[CUSTOMER][NEUTRAL] I have no idea. It's [PII]. It's an [PII] facility.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The reason I'm asking is because it will be covered if it's, if he's sending the equipment that he gives back, he has to take it back to a facility so that they can run the test.
[AGENT][NEUTRAL] So if that is an outpatient facility, yes, it will be covered under this policy.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] But the durable medical equipment, there's no coverage on this policy for durable medical equipment, but she
[CUSTOMER][NEUTRAL] Yeah, and that could be expensive I know.
[AGENT][NEUTRAL] Yeah, but she did stress as long as it's outpatient, that's why I asked like that, as long as it's outpatient where he's sending it back to so that the test can be ran from, you know, whatever it recorded, then yes, because he has the um
[AGENT][NEUTRAL] Outpatient facility treatment.
[CUSTOMER][NEGATIVE] OK, alright, so that is part of our stuff because the lady that I talked to a little while ago was saying it has to be done inside a hospital, and I'm like, what a waste of time.
[AGENT][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] So you're telling me it can be done at his house.
[AGENT][NEUTRAL] Yeah, that's why I wanted to wait, that's why I wanted to check with claims cause those sleep studies are, that's a, that's a tricky one because sometimes they, it's done at a facility, sometimes it's like he's doing, but wherever he takes that back to, because that's where all that coding is gonna come from, not where he was sleeping. So yeah, that's, it will be up to that 5350.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so I, I, I'm not sure what health insurance he has or what he's going for, um, policy wise. OK, that's what I needed to know. I appreciate it. I'll let him know.
[AGENT][POSITIVE] Alright, I'm sorry for that wait, but I'm glad I was able to help you. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, make, make it not a Monday.
[AGENT][POSITIVE] All right, well thanks
[AGENT][POSITIVE] Well, hopefully you get [PII]'s [PII] off, so we have a break coming. I'm counting down.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I get you. Well, have a good one. Thank you so much for your time.
[AGENT][POSITIVE] You too. Thanks for calling ATL. Happy [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.