AccountId: 011433970860
ContactId: af22f8fd-b7a8-4ac3-bd1d-1bc90bee31fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 526549 ms
Total Talk Time (AGENT): 209336 ms
Total Talk Time (CUSTOMER): 193196 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/af22f8fd-b7a8-4ac3-bd1d-1bc90bee31fd_20250211T20:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. Um, I'm calling from an, um, a DME company, more or less like an equipment company. We have a patient and we supply, um, or we provide her supplies for an equipment that she, she uses like every 3 months.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She's got a co-payment because apparently with this premium or this primary coverage that she has, she still has um a deductible that hasn't been met and we sent her the uh quote, and she's asking us to check with you guys to see if you cover this by any chance. I can give you her ID number and I have all her information. Could you check that for me, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I can check and see if um DME equipment or durable medical equipment is covered on the policy. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Absolutely, ma'am. My name is [PII].
[CUSTOMER][NEUTRAL] And a direct number to contact me. Let me just make sure because I don't know. I still don't know that by heart. uh [PII].
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] [PII] and I'm at extension [PII].
[AGENT][NEUTRAL] Thank you for that and then just the policy number.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, her policy number is.
[CUSTOMER][NEUTRAL] Member ID number, it says 60801.
[AGENT][NEUTRAL] So that's the payer ID, um, do you see anywhere that says in hospitals or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] No, this is a this is a third party company that helps us or assist us with customer service and they collected that in a group ID, the group number, that's it.
[AGENT][NEUTRAL] What's the group number?
[CUSTOMER][NEUTRAL] So not 25921.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the member's first and last name?
[CUSTOMER][NEUTRAL] First name is [PII] and that's [PII] and her last name is [PII]. I really don't know how to pronounce it, but it's [PII]. I don't know.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And you said it was group number 25921?
[CUSTOMER][NEUTRAL] 25921, yes, ma'am.
[CUSTOMER][NEUTRAL] 60805 is the payer ID.
[AGENT][NEUTRAL] Let me see if I can search with just the last name. I'm looking under the group, um, but there, there, there's no.
[AGENT][NEUTRAL] Name matching hers under the group, um.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Hold on one second, I don't even see a [PII].
[AGENT][NEUTRAL] Do you happen to have, oh no, you said a third party. OK. Let me try her name. If not, we're gonna need more information.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said last name is [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] I found one with her last name. Hold on one moment, it's coming up now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, she's not the policyholder. OK, that's why I didn't show up under the group. OK, can you verify her date of birth for me, please?
[CUSTOMER][NEUTRAL] Absolutely. [PII].
[AGENT][NEUTRAL] All right, and all the information provided is a verification of benefits, not a guarantee of payment. Um, so the policy number is 249.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0 249.
[AGENT][NEUTRAL] 1476.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see if DME is covered. Hold on one moment.
[AGENT][NEUTRAL] OK, so under the outpatient benefits, the policy will pay up to $250 per day.
[AGENT][NEUTRAL] On outpatient expenses and that does include, um, she has a durable medical equipment rider, so durable medical equipment would be covered up to the $250 per calendar day. But let me pull the policy because I think there's some uh specifications. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment, a minute.
[CUSTOMER][POSITIVE] Mhm take your time no worries.
[AGENT][NEUTRAL] I thought it gave specifications, but it doesn't. Um, so yeah, the durable medical equipment rider is up to that $250 per day, um.
[AGENT][NEUTRAL] It just needs to be recommended by a physician or covered medical plan and um there's something about disposable. Hold on one second.
[AGENT][NEUTRAL] Yes, it's not listed on here. So, um, for the most part, I would just go with the $250 per calendar day and then um the only stipulations that I see here are as long as it's um
[AGENT][POSITIVE] Recommended by a doctor.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Which it is.
[CUSTOMER][POSITIVE] Actually it's a specialist. It should be a pulmonologist, the one that's recommending this.
[AGENT][NEUTRAL] Here it is, this is what I was looking for, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Durable medical equipment um has to withstand repeated use, is not disposable.
[AGENT][NEUTRAL] Um, it is not implantable within the body. It's covered by the other medical plan and it's um,
[AGENT][POSITIVE] Appropriate for use or primarily used within the home.
[CUSTOMER][NEUTRAL] OK, so it's not implantable you said it, it cannot be disposable?
[AGENT][NEGATIVE] Right, not disposable.
[CUSTOMER][NEUTRAL] Well, it's kind of disposable because these are supplies that we that she's supposed to change every 3 months so then that doesn't fall within the category that that actually falls within the category of disposable.
[CUSTOMER][NEUTRAL] I mean it's not like the equipment, the equipment that we're providing the supplies for, she doesn't throw away, but the supplies she will. She needs to change them every 3 months, so basically everything that we're gonna be sending her, it's basically disposable so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Then the supplies are not within the category probably an equipment that you continues using.
[AGENT][NEUTRAL] The best thing to do would be to go ahead and file a claim and let the examiner process it because I don't know what they, I mean, under the policy it says it is not disposable um and has to withstand repeated use. I don't know if there's a limit for that, so I would just go ahead and and um send in the claim so we can process it and let you know.
[CUSTOMER][NEUTRAL] It will.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, perfect. So you said again that her policy number or the member number is 2491476?
[AGENT][POSITIVE] Mhm, that's correct.
[CUSTOMER][NEUTRAL] And the group is 25921. I have the payer ID is 60801, and you guys are non just like that a APL.
[AGENT][NEUTRAL] Say that one more time.
[CUSTOMER][NEUTRAL] Are you guys are not as just like like that right? APL.
[AGENT][NEUTRAL] Right, AP, I mean, it stands for American Public Life, but yes, APL.
[CUSTOMER][NEUTRAL] Like, basically the
[CUSTOMER][NEUTRAL] American Public life OK.
[AGENT][NEUTRAL] Alright, and [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] All right, ma'am.
[CUSTOMER][POSITIVE] No, ma'am, that'd be all, and I appreciate your assistance today.
[AGENT][POSITIVE] Yes, very welcome, and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.