AccountId: 011433970860
ContactId: 9dd50f75-787c-4fa1-93bd-3a59c9d5d38f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225809 ms
Total Talk Time (AGENT): 129917 ms
Total Talk Time (CUSTOMER): 57689 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/9dd50f75-787c-4fa1-93bd-3a59c9d5d38f_20250411T18:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling with Colorado Medical Solutions. I'm trying to verify a patient's eligibility.
[AGENT][NEUTRAL] OK, yeah, I can check eligibility for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] My direct number is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] 025867557
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that, [PII]. So this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] OK, does it, how much does it pick up? Does it pick up all of the co-insurance or just a portion?
[AGENT][NEUTRAL] No, it is uh a specific amount uh was this for inpatient or outpatient?
[CUSTOMER][NEUTRAL] It's for outpatient durable medical equipment.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so both inpatient and outpatient benefits are on a per calendar year basis. Outpatient is $1000 max per calendar year. If you give me one moment, I'll see if any of that has been used.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Of course, OK, so she has used $380 of that benefit so far this year.
[CUSTOMER][NEUTRAL] OK, so how does it work? Does it just pick up until it's met that max or?
[AGENT][NEUTRAL] Correct, yes, uh, anything towards, uh, as long as Major medical is willing to pay, it helps to go towards, uh, co-pay, deductible or co-insurance until that benefit has reached its maximum, and then it of course restarts the calendar year.
[CUSTOMER][NEUTRAL] Got you OK all right perfect and then where do we submit the claims?
[AGENT][NEUTRAL] Um, so I've got a mailing address, a fax number, and a payer ID. Did you want me to give you all of those?
[CUSTOMER][NEUTRAL] Um, I'll take the address and the payer ID.
[AGENT][NEUTRAL] OK, so our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] Perfect. OK. And then what was that payer ID?
[AGENT][NEUTRAL] OK, and then that payer ID, yes, that is 60801.
[CUSTOMER][NEUTRAL] OK, perfect. So you guys are gonna pick up coinsurance and deductible until the patient reaches the max and then they're responsible after that?
[AGENT][NEUTRAL] And co-pay, um, we don't say what is patient responsibility that is up to the provider but yes, we will pay up until that maximum has been reached.
[CUSTOMER][NEUTRAL] Got it. OK, perfect. Can I just get the first initial of your last name and a call reference?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] That's all thank you I appreciate it.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APO. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][POSITIVE] Thanks bye.