AccountId: 011433970860
ContactId: ad6fdd3e-e684-4753-ad1c-816a3d9ac512
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388160 ms
Total Talk Time (AGENT): 125670 ms
Total Talk Time (CUSTOMER): 111116 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/ad6fdd3e-e684-4753-ad1c-816a3d9ac512_20250331T17:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good day. This is [PII] from All Saint Home Medical. I'm calling to check patient eligibility and benefits.
[AGENT][POSITIVE] OK, [PII], I can help you with eligibility and benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Um, that will be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, yes, um, policy number is 02566496.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Uh, one moment for the date of birth.
[CUSTOMER][NEUTRAL] For the date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm, I'm sorry, it's [PII].
[AGENT][POSITIVE] OK, great, thank you.
[AGENT][NEUTRAL] OK, and what kind of benefits?
[CUSTOMER][POSITIVE] Oh, sorry about that.
[AGENT][NEUTRAL] That's OK. What kind of benefits were you needing?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um, the CPT code is E0601.
[AGENT][NEUTRAL] Um, what's the description of that?
[CUSTOMER][NEUTRAL] Um, CPAP, uh, DME.
[AGENT][NEUTRAL] OK, durable medical equipment. OK, let's see if she has coverage for that.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, this is not a guarantee of payment. It's a basic outline of the policy. I do show our active and effective [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] So for her durable medical equipment benefit, she has a
[AGENT][NEUTRAL] $3000 maximum per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is a uh supplemental policy so it does work um as secondary so we'll need the primary explanation of benefits filed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the $3000 is the individual out of pocket.
[AGENT][NEUTRAL] No, that's the that's the amount payable per calendar year, so that's the most that we'll pay in a calendar year for outpatient services, durable medical equipment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about for the individual deductible?
[AGENT][NEUTRAL] Um, it's there's, this is a secondary policy, so this, this policy helps pay for deductibles, co-pays, and co-insurance.
[AGENT][NEUTRAL] So we'll have to have the primary explanation of benefits. Whatever's left over from the primary, we will pick up and pay up to 3000.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, right. Um, so does the secondary policy cover the primary deductible?
[AGENT][NEUTRAL] Yes, up to that 3000 mark, yeah.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Oh, so the $3000 must be paid first?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Must be satisfied
[AGENT][NEUTRAL] No, so we will pay a secondary. So let's say primary submitted a claim for $1000 and it all went towards the patient's deductible.
[AGENT][NEUTRAL] We would potentially pay the entirety of that because that was what primary had left over, so they didn't pay anything. We will, this helps pay for deductibles, co-pays and co-insurance, but the primary does not pay.
[CUSTOMER][NEUTRAL] Oh, alright, got it.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, got it. Um, so the percentage, right, so the percentage of coverage is 100%.
[AGENT][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] Yes, 100% up to 3000 after the primary has paid.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Alright, got it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So for the secondary, no deductible, no out of pocket.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. Um, so no authorization is needed?
[AGENT][NEUTRAL] That is correct, no authorization.
[CUSTOMER][NEUTRAL] All right, got it. And lastly, um, can I have our reference number for this call?
[AGENT][NEUTRAL] Uh, reference number is just my first name, [PII], last initial D as in dog, and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Uh, [PII], thanks so much for your help and assistance. Have a wonderful day.
[AGENT][POSITIVE] Thank you for calling APL. You have a great day too.
[CUSTOMER][NEUTRAL] Mhm bye for now.
[AGENT][NEUTRAL] Bye.