AccountId: 011433970860
ContactId: 8eff664e-3a13-48da-b6a1-a7b834dc2344
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 638570 ms
Total Talk Time (AGENT): 235308 ms
Total Talk Time (CUSTOMER): 278539 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/8eff664e-3a13-48da-b6a1-a7b834dc2344_20250425T16:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. Um, I think I have the wrong option. I'm not really sure. Do you guys offer medical coverage for DME?
[AGENT][NEUTRAL] It's according to what policy the member has.
[CUSTOMER][NEUTRAL] OK, so, so it is offered through your company then.
[AGENT][NEUTRAL] It's just according to what policy we do have different benefit packages.
[CUSTOMER][NEUTRAL] Oh got you OK I didn't know if that was like in one of them or anything like that because the option selection screen I was just on, it said something about dental and then MediCal and then something else but none of it said medical so I wasn't sure I guess Medial is maybe medical.
[CUSTOMER][NEUTRAL] Not really sure.
[AGENT][NEUTRAL] OK, you're talking about for the selection on the phone?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, did it say gap?
[CUSTOMER][NEUTRAL] Yes, would that be your medical policies?
[AGENT][NEUTRAL] That is our supplemental policy, yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know. I, I have a customer I have a patient ID here if that helps.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, are you the provider?
[CUSTOMER][NEUTRAL] Yeah we're the provider.
[CUSTOMER][NEUTRAL] Um, it's, it's from Dina Slint Systems Incorporated. Did you need the NPI?
[AGENT][NEUTRAL] I'm needing your callback number and then the member's policy number.
[CUSTOMER][NEUTRAL] OK, so my callback number is [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah it's gonna be 02493350.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And did you need the patient's name and date of birth as well?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's going to be [PII], [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy. So you're calling in for durable medical equipment?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] Just to verify eligibility and DME benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And for this member, verification of coverage does not guarantee the payment of the claim. This policy is showing currently active with the effective date of [PII]. For DME, the member does have up to $6800 per calendar year. They do have a $1500 deductible, and that $6800 will go towards the primary insurance deductible, co-insurance, or co-pay.
[AGENT][NEUTRAL] This policy is for sickness and injury. It will not cover any type of preventative or wellness. And for the DME it does not cover disposable, non-disposable. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, yes, I just wanted to go over a few things real quick, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On this, sorry my computer was running a little slow while you were telling me the information so the deductible, so the coverage is at 100% once the deductible is met then right?
[AGENT][NEUTRAL] The coverage is up to the $6800 per calendar year.
[CUSTOMER][NEUTRAL] Um, yeah, but like while that's being used it's covered at 100% until that's used, right?
[AGENT][NEGATIVE] Well, I can't say that it's covered at 100%.
[CUSTOMER][NEUTRAL] Like, is there like for example.
[CUSTOMER][NEUTRAL] Yes, I'm sorry, let me explain that a little bit better. So like for example, is this like let's say, uh well, um, is it covered like is there a co-insurance or like a copay or just a deductible and then it's covered at 100% until they use the 600 or $6800 and then that's it, right?
[AGENT][NEUTRAL] Once the mirror meets the $1500 we then will pay up to the $6800 of the primary insurance deductible co-insurance or co-pay.
[CUSTOMER][NEUTRAL] Right, so the reason I'm asking is this is for a rental?
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] How would like
[CUSTOMER][NEUTRAL] Do you, do you understand what I'm saying? Or am I not making any sense really?
[AGENT][NEUTRAL] OK. So, whatever the primary insurance applies to the member's responsibility, we then will receive the primary EOB.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] If the member has not met that $1500 deductible for us, then that is the amount that we would apply towards her responsibility. So say for instance if the primary says that it's gonna be $200 applied to the member's deductible co-insurance or co-pay.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When we receive it, if the $1500 has not been used, we then would apply that $200 to this member's deductible, which they are responsible for out of pocket.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right, but if they met their deductible, then you guys would pay that $200 because it's under $6800 right?
[AGENT][NEUTRAL] As long as they hadn't met the $6800 that we, that we've paid out, then they do have the $200.
[CUSTOMER][POSITIVE] Perfect. OK, that's what I was that's what I was wondering have they met any of their deductibles so far?
[AGENT][NEGATIVE] As of right now, the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] OK, um, and.
[CUSTOMER][NEUTRAL] I'm assuming you guys don't offer any kind of like out of pocket for this since you have a DME max, right?
[AGENT][NEUTRAL] No, we don't have an out of pocket or anything like that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, um,
[CUSTOMER][NEUTRAL] Sorry, this is just the, the first time I've, I think I've ever had to verify this insurance so I, I'm just a little confused about how it all works. I'm trying to understand it myself.
[AGENT][NEUTRAL] Yes, we're just, we're just considered like their secondary supplemental or gap coverage. So it's just based off of the benefit package.
[CUSTOMER][NEUTRAL] OK, so you guys, so you guys are essentially like a supplemental plan with the DME max or well with a max, not necessarily for DME, but OK, that makes more, that makes way more sense. Have they met any of their maximum so far? or you said they haven't used any, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] They haven't used any of their benefits.
[CUSTOMER][NEUTRAL] OK, so I'll put that as 0 me then and then um is there a name for this policy?
[AGENT][NEUTRAL] This is a midlink plan.
[CUSTOMER][NEUTRAL] Medli plan OK and then are you guys considered a commercial Medicare or Medicaid?
[AGENT][NEUTRAL] We're not considered any type of major medical.
[CUSTOMER][NEUTRAL] Line of business.
[CUSTOMER][NEUTRAL] OK and then um do you know what type of policy this is?
[CUSTOMER][NEUTRAL] What it's classified as like a PPO and HMO or anything like that or just a supplemental?
[AGENT][NEUTRAL] It's just a supplemental, we're not a major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK and um does in or out of network status matter for you guys or no?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And is there a group number for billing purposes?
[AGENT][NEUTRAL] Let me get that for you.
[AGENT][NEUTRAL] The group number is showing 19344.
[CUSTOMER][NEUTRAL] OK, and this plan runs off of a calendar year you said right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] The patient is the policy holder.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and are you showing any other health insurance listed or no?
[AGENT][NEGATIVE] No, we wouldn't have access to that.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Do you guys.
[CUSTOMER][NEUTRAL] Do you require authorization?
[AGENT][NEUTRAL] No office required.
[CUSTOMER][NEUTRAL] OK, and you guys don't require a PCP referral, right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that makes a little bit more sense then.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, do you have a claims address for me?
[AGENT][NEUTRAL] Yes, let me get that for you. That would be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And that [PII] right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] OK, sorry to have you keep repeating myself. My computer is just running so slow today for no reason.
[AGENT][POSITIVE] Oh, it's no problem.
[CUSTOMER][NEUTRAL] Um, do you guys have a payer, an electronic payer ID?
[AGENT][NEUTRAL] Yes, that will be 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0, 801-60801. OK, and can I get the spelling of your first name please?
[AGENT][NEUTRAL] Yes, the reference would be my first name spelled [PII]
[AGENT][NEUTRAL] [PII] in today's date.
[CUSTOMER][NEUTRAL] OK and you said that's the call reference number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right sounds good then.
[AGENT][NEUTRAL] OK, is there anything else that I can assist you with today, [PII]? Go ahead.
[CUSTOMER][NEUTRAL] And then um do you guys.
[CUSTOMER][NEUTRAL] Yeah, um, just one quick question and this is more so like, um, following how the policy applies coverage.
[CUSTOMER][NEUTRAL] Would you do you guys.
[CUSTOMER][NEUTRAL] Work as a supplemental with the primary is a commercial plan or only for Medicare plans?
[AGENT][NEUTRAL] If they have primary like UnitedHealthcare or anything, we use that as well, as long as they have a primary insurance.
[CUSTOMER][NEUTRAL] OK, that's fine. I just wanted to make sure it works so even if the primary is a commercial because the only supplementals I really dealt with, to be honest, is Medicare supplementals, so I was just trying to like learn a little bit more.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][POSITIVE] All right um well thank you so much I appreciate all your help.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life, [PII]. Have a great day and enjoy your weekend.
[CUSTOMER][POSITIVE] You do the same thank you so much.
[AGENT][POSITIVE] Thank you. Bye-bye.