AccountId: 011433970860
ContactId: 8fb6c003-8213-4293-9df9-e4220bc2ac5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368470 ms
Total Talk Time (AGENT): 145177 ms
Total Talk Time (CUSTOMER): 119049 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/8fb6c003-8213-4293-9df9-e4220bc2ac5a_20250418T18:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from a provider's office. I'm calling because I have a patient who um has American Public Life for their secondary insurance, and I'm just trying to find out if you guys will um cover this medication, um, after it processes through her primary insurance. Would you be able to help me with this?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with um the patient's benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. My phone number is [PII]. That's my direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02588693
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I do see the policy is active, it's been effective since [PII].
[AGENT][NEUTRAL] And hold on one moment, let me see the benefit.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. So for the secondary policy, there is no coverage for um prescriptions or medication. It's more so inpatient facilities and outpatient facilities.
[CUSTOMER][NEUTRAL] OK, so she's gonna be have uh I don't know how it works it's.
[CUSTOMER][NEUTRAL] it's a medical infusion.
[CUSTOMER][NEUTRAL] That is administered in a provider's office.
[CUSTOMER][NEUTRAL] So it typically falls under the medical benefit, not typically.
[CUSTOMER][NEUTRAL] Falls under the medical benefit um through the primary insurance so would you guys pick up the secondary portion of it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So if it's considered an in-office procedure, then um they do have the office treatment rider um for any procedures done in the physician's office or specialist's office. So for that benefit, um, hold on one moment, let me make this smaller.
[AGENT][NEUTRAL] We would pay up to $2,025 per calendar year per person towards their outpatient um expenses. Did you want me to see if any for this year?
[CUSTOMER][NEUTRAL] Yes please and how much was that? 2500?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 1500.
[AGENT][NEUTRAL] And so far, she has not used any of the benefits for [PII], so she still has that full balance.
[CUSTOMER][NEUTRAL] OK, um, and, um, I think you had said if it was done in the office, um, as a procedure, but if it's a if it's an infusion, is that still the same?
[CUSTOMER][NEUTRAL] I just wanna make sure she's covered, you know what I mean.
[AGENT][NEUTRAL] So the secondary policy doesn't really focus on what's done, it's where. So if it's a um physician's office, the benefit, hold on one moment, let me go back to that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, they have infusion therapy in a center hospital or facility or physician's office. Um,
[AGENT][NEUTRAL] And that's under their outpatient benefits and they also have, where is the
[AGENT][NEUTRAL] Surgery or treatment in a um physician's office. So there is coverage, but the only way to definitely guarantee is to process the claim.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Does the patient have to submit the claim? I, I mean, it hasn't happened yet. I'm just, um, so that way I know what's gonna happen. Um, does the patient submit the second, OK, wait a minute. Does the patient submit her EOB to you guys after the primary has paid, or, uh, is that like us we handle that. I just wanna make sure.
[AGENT][NEUTRAL] Yes, the provider um handles it after you receive the explanation of benefit from her uh Health Easy policy, um, that will be sent to us to process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, perfect. Can I, um, just get a call reference number for today [PII] that that'd be it.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, all right, thank you so much and I hope you have a great day.
[AGENT][POSITIVE] You're very welcome. You also, [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Are you talking about at home?
[CUSTOMER][NEUTRAL] Bye bye.