AccountId: 011433970860
ContactId: 94a886e3-a214-4cf6-9432-14c1d3398cb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431559 ms
Total Talk Time (AGENT): 184180 ms
Total Talk Time (CUSTOMER): 119129 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/94a886e3-a214-4cf6-9432-14c1d3398cb9_20250521T19:21_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] Hey, [PII]. This is [PII] and the last name is [PII] calling from rendering facility for eligibility and benefits of a patient today. Can you please help me with that?
[AGENT][NEUTRAL] OK, and you have one patient that you're needing eligibility and benefits for, is that correct?
[CUSTOMER][POSITIVE] Mhm. You're right.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And and what is your callback number?
[CUSTOMER][NEUTRAL] And the callback number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Um, it is 02483110.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information and that I do provide 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] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on this supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, it is for outpatient and it is delivered to patients home. It is for durable medical equipment, CPAP supplies.
[AGENT][NEUTRAL] OK. So the policy does have benefits for DME. however, disposable supplies are not covered under this policy.
[CUSTOMER][NEUTRAL] So, it is for CPAP supply, so it doesn't cover under the patient's policy.
[AGENT][NEUTRAL] If it is disposable supplies, that is excluded.
[CUSTOMER][NEUTRAL] Mhm. OK. Just give me a second.
[AGENT][NEUTRAL] It must be able to withstand repeated use.
[CUSTOMER][NEUTRAL] OK. So, it can be repeatedly used so it is covered, right?
[AGENT][NEUTRAL] The definition of durable medical equipment on this policy and states that it can withstand repeated use, is not disposable or refillable, is used to serve a medical purpose, and is not useful to a person in the absence of sickness or injury, is appropriate for use and primarily used within the home, is not implantable within the body, and is covered under the other medical plan.
[CUSTOMER][NEUTRAL] Mhm. And can I have the plan type, please?
[AGENT][NEUTRAL] Medin supplemental.
[CUSTOMER][NEUTRAL] And can I know the primary insurance, please, ma'am?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just one second please.
[CUSTOMER][POSITIVE] Sure, ma'am. Take your time.
[AGENT][NEUTRAL] Do you, would you like for me to give you what the outpatient benefit maximum is for covered outpatient services?
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $9100 with no deductible.
[CUSTOMER][NEUTRAL] OK, is $9100 and there is no deductible and is there any accumulation right now for this plan?
[AGENT][NEUTRAL] I'm sorry, ask the last question again?
[CUSTOMER][NEUTRAL] Is there any met amount or accumulation?
[AGENT][NEUTRAL] I can check that for you, one moment.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] As of now, no benefits have been used for this calendar year.
[CUSTOMER][NEUTRAL] Mhm. Thank you for that. Uh, and can I know the primary insurance, please?
[AGENT][NEUTRAL] According to our records for her employer that is Allstate.
[CUSTOMER][NEUTRAL] Mhm. Thank you for that. And uh will you cover the leftover of primary insurance fully?
[AGENT][NEUTRAL] Again, I can only provide benefits. I cannot guarantee payment. We will have to receive the claim along with a copy of the primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] Mhm. OK. Thank you for that. And uh just give me a second, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh OK, just give me a minute. And can I know the coinsurance percentage for durable medical equipment?
[AGENT][NEUTRAL] Again, this is a supplemental policy to her primary insurance that helps her with her co-pays, deductibles, and co-insurance amounts of coverage services.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you for that. Uh, and have a great day and stay safe. And can I have the call reference number, please?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes and uh one more piece of information before we go, if you all do file a claim with us once it has been processed, we do have a portal in which you should be able to check claim status and our website for the portal is located at [PII].
[AGENT][NEUTRAL] And for your call reference number you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you for that and thank you for your assistance. Have a great day and stay safe and bye for now.
[AGENT][POSITIVE] OK, and well, I have the same things for you and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mhm.