AccountId: 011433970860
ContactId: 9f3baef3-96bd-4fdd-a570-7e70ddd1e587
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393239 ms
Total Talk Time (AGENT): 186343 ms
Total Talk Time (CUSTOMER): 123127 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/9f3baef3-96bd-4fdd-a570-7e70ddd1e587_20250617T16:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi.
[CUSTOMER][NEUTRAL] Uh, good morning. My name is [PII]. I'm calling from for office. I want to know the eligibility and benefit for the patient's plan is for the medical.
[AGENT][NEUTRAL] OK, you're OK, you're needing eligibility and benefits for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And I'm sorry, what is your name again?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. It's [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, the gentleman, thank you and what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mm. Yes.
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Uh, that's gonna be 01845878 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I mean, again, any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do show that he is the subscriber on this supplemental policy because John and the effective date is [PII] and this policy is active.
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It is like uh you said it's a medical supplement plan, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh no, it's a supplement plan.
[AGENT][NEUTRAL] This is a supplemental plan, correct.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, OK. And what type of plan is the plan G, plan I right?
[AGENT][NEUTRAL] We are not a major medical insurance company, so there's no plan type number. This is just a supplemental plan to his primary insurance.
[CUSTOMER][NEUTRAL] OK. Uh, uh, so I, uh, require the, uh, infusion drug benefit for the place of services home, and I have the procedure code and the procedure codes are J as in Juliet, 1335 and it.
[AGENT][NEGATIVE] OK, that's not, yeah, so that's not going to help me. Um, the procedure code is not, I don't need that. So this, you said this is for home, what type of home service?
[CUSTOMER][NEUTRAL] OK, provide me that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Infusion, infusion drug benefit for the place of services.
[AGENT][NEUTRAL] OK, so there are no benefits for services in the home.
[CUSTOMER][NEUTRAL] Yes, infusion, in for the infusion.
[AGENT][NEUTRAL] Yes, sir. And that would not be covered by this plan.
[CUSTOMER][NEUTRAL] Uh, inefficient drug not covered under, under the home, for the home.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Which one?
[AGENT][NEGATIVE] It is not covered in the home. Home services are not covered.
[CUSTOMER][NEUTRAL] Home services are not for this plan. OK. There is a plan exclusion, correct?
[AGENT][NEUTRAL] Yes, so this is the supplemental policy would not cover an in-home infusion therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] [PII]. My name in today's date will be your call reference number. Now if you all do end up filing a claim with APL on this policy, the gentleman, we would also have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Yeah, just a moment. Could you please check, uh, um, for me the benefit for the COB, uh, there is any other insurance policy, which is the primary insurance?
[AGENT][NEUTRAL] You're asking me what the primary insurance company is?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] According to our records for this gentleman's employer, their primary insurance company is through Cigna.
[CUSTOMER][NEUTRAL] OK. Uh, when, when, uh, when's the last you get it?
[AGENT][NEUTRAL] I'm sorry, you would have to I don't have any information on his primary insurance.
[CUSTOMER][NEUTRAL] No, no, I'm asking about the last UOB, the coordination of benefit when it was last updated.
[AGENT][NEUTRAL] There would not be a coordinate. Yes, sir. There would not be a coordination of benefits with APL as I have explained, We are not a major medical insurance company. This is only a supplement that helps with co-pays, deductibles and co-insurance amounts of covered services.
[CUSTOMER][POSITIVE] OK, perfect. No worries. Thank you, thank you very much, uh, provide me the card reference number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name and today's date and then lastly if you all do file a claim, as I said to send the EOB from his primary insurance with the claim and then once we've processed the claim here at APL we do have a portal that you should be able to check claim status in and the website for that portal on it is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Thank you, thank you very much. Have a wonderful day. Bye-bye.
[AGENT][NEUTRAL] Well, I hope you have