AccountId: 011433970860
ContactId: ac4a9b82-49b5-448e-bb4f-f51224d9ad11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352019 ms
Total Talk Time (AGENT): 145868 ms
Total Talk Time (CUSTOMER): 139658 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/ac4a9b82-49b5-448e-bb4f-f51224d9ad11_20250116T14:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], hi, my name is [PII], and this call is being recorded for quality assurance and training purposes. I'm calling on behalf of patient [PII]. I'm trying to check eligibility and benefits for an infusion.
[AGENT][NEUTRAL] OK, and [PII], what is your callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] My extension is [PII].
[AGENT][POSITIVE] Thank you and what's that?
[AGENT][POSITIVE] OK, thank you so much and what is that policy number please for the patient?
[CUSTOMER][NEUTRAL] I have 980751.
[AGENT][NEUTRAL] OK, 90751 and verify the patient's date of birth.
[CUSTOMER][NEUTRAL] Um, Patience [PII], [PII].
[AGENT][POSITIVE] OK, thank you so much one moment.
[AGENT][NEUTRAL] OK, have a member pulled up. You're calling for eligibility and benefits. Um, the patient shows effective as of [PII], and the policy shows active.
[AGENT][NEUTRAL] And for benefits, one moment please.
[CUSTOMER][NEUTRAL] What type of plan is this, and can you see if this plan coordination of benefits also?
[AGENT][NEUTRAL] This is a supplemental medical policy, supplemental to a major medical.
[CUSTOMER][NEUTRAL] OK, does it follow the plan's guidelines or it follows has its own guidelines?
[AGENT][NEUTRAL] As a supplemental medical, we follow the, actually, we help with the major medical deductible, co-pay and co-insurance based on coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it is um it considered the primary remaining expenses up to 100%.
[AGENT][NEUTRAL] Well, for well, for covered services we pay up to $500 per day. Please note verification of benefits provided does not guarantee payment. Again, we pay up to $500 per day for covered services and we help depending on what the major medical applies charges to the deductible copay or coinsurance for cover services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, will claims cross over with this plan with the, the primary or does not cross over?
[AGENT][NEGATIVE] It does not cross over.
[CUSTOMER][NEUTRAL] OK, and can the provider, so the provider can buy or especially especially pharmacy, so the provider can only buy and be a special pharmacy is not an option, correct?
[AGENT][NEGATIVE] Correct. It has no benefits for um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Prescription.
[AGENT][NEUTRAL] medication.
[CUSTOMER][NEUTRAL] OK, and what's the claims address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] I'm sorry, bless you. [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And referrals and authorizations won't be required, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And plan runs on calendar year and it's not on the exchange or by the APA just a supplement. Is this like a non-standard supplement or does it have a letter behind it?
[AGENT][NEGATIVE] It does not run by calendar year a per day max of $500.
[CUSTOMER][NEUTRAL] Per day max, OK.
[AGENT][POSITIVE] Yes, no, there's no, uh no problem, no problem, no problem, no, there's no letter behind it.
[CUSTOMER][NEUTRAL] OK, I'm sorry, I, you told me that, OK.
[CUSTOMER][NEUTRAL] OK, and is there a group number or employer name for this plan?
[AGENT][NEUTRAL] Yes, there's a group number and that group number shows one moment.
[AGENT][NEUTRAL] 16312.
[CUSTOMER][NEUTRAL] The group name.
[AGENT][POSITIVE] Yes. Healthy mothers, healthy babies.
[CUSTOMER][NEUTRAL] OK, is it fully funded or self funded?
[AGENT][NEUTRAL] Um, this is through the employer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And not a CO plan, the in and out of network, does it apply?
[CUSTOMER][NEUTRAL] For the supplement.
[AGENT][NEUTRAL] No, what, there's no network. No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and no lifetime max or benefit cap.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] You said $500 per day, OK.
[AGENT][NEUTRAL] It's per day.
[CUSTOMER][NEUTRAL] Alright, and I'm just trying to make sure I got all my questions. OK, and your first name was [PII]
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the first initial of your last name [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And do you have a, and do you have a reference number?
[AGENT][NEUTRAL] No, you can use my name in today's date, [PII]. Any anything else? Oh, we have a payer ID and the fax number if you need those as well.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, yeah, you can give them to him. I can make a note of it.
[AGENT][NEUTRAL] OK, the fax number is [PII].
[AGENT][NEUTRAL] Payer ID is 608. I'm sorry.
[CUSTOMER][NEUTRAL] I had
[CUSTOMER][NEUTRAL] Never mind.
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry, I'm thinking out loud. Go ahead, pay ID is what?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said the reference number would be just your name and today's date.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you, have a good day.
[AGENT][POSITIVE] You as well, [PII]. Thank you for calling APL. Take care. Mm bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.