AccountId: 011433970860
ContactId: a922ee98-49d0-4d2a-9eb0-51e2ffe3e664
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 224960 ms
Total Talk Time (AGENT): 107028 ms
Total Talk Time (CUSTOMER): 52607 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/a922ee98-49d0-4d2a-9eb0-51e2ffe3e664_20250506T19:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII]. I'm calling you from Texas Home Medical, and I'm calling because I need to verify benefits for DME.
[AGENT][POSITIVE] OK. Happy to check benefits, [PII]. Do you have their policy number?
[CUSTOMER][NEUTRAL] Yes, it's gonna be, well, I'm not sure if it's the 21628.
[AGENT][NEUTRAL] No, it sounds like more like a group number. It should be like a certificate number.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Is it 01907334?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That sounds all right. Let me pull this up.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] All right, perfect. Thank you. So, patient is active. Effective date on here is [PII].
[AGENT][NEUTRAL] We're their secondary insurance, [PII], so give me just a second. I'm gonna pull this up and see if it has any benefits for DME on here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it looks like durable medical equipment is covered under the member plan. Um, it is under their outpatient benefits and so their benefit max for the year is $4000 on this plan, it looks like.
[CUSTOMER][NEUTRAL] OK, so they have a $4000 deductible they have to meet first?
[AGENT][NEUTRAL] No, no, no, no, no. $4000 is the most the plan will pay out of pocket. This is a secondary insurance, so there is no deductible or anything like that. We pick up deductible, co-pay and co-insurance from the primary.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does it show that we are in network with this patients plan?
[AGENT][NEUTRAL] There's no network required it follows, like I said, the primary.
[CUSTOMER][NEUTRAL] OK, effective date again? I'm sorry, it was [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, [PII]. Uh-huh.
[CUSTOMER][NEUTRAL] OK, and then claim address?
[AGENT][NEUTRAL] Claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] We do also have a fax and payer ID if you would like that.
[CUSTOMER][NEUTRAL] Mm, no, and then I get a reference number for this call.
[AGENT][NEUTRAL] Call reference is my name with my last initial and today's date. My name again is [PII], that's [PII] and last initial, my name is [PII].
[CUSTOMER][POSITIVE] In today's day, alrighty, that's actually all I needed for today.
[AGENT][POSITIVE] All right. Have a good one, [PII].
[CUSTOMER][POSITIVE] Thank you you too mhm bye.
[AGENT][NEUTRAL] Bye bye.