AccountId: 011433970860
ContactId: b0a51b52-a4bf-4d21-b8d4-64fe7e26c6c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 488220 ms
Total Talk Time (AGENT): 229857 ms
Total Talk Time (CUSTOMER): 140148 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/b0a51b52-a4bf-4d21-b8d4-64fe7e26c6c6_20250217T20:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and this call is regarding to verify your eligibility and benefits. So could you please help me with that?
[AGENT][NEUTRAL] Sure, I can assist you with the eligibility and benefits, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK. And what's the name of the facility or place that you're calling from?
[CUSTOMER][NEUTRAL] Sleep remedies.
[AGENT][NEUTRAL] I'm sorry, what's the name?
[CUSTOMER][NEUTRAL] Sleep remedies.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The patient policy number is 01792127.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK. The patient name for this member is [PII] Overhas date about [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, and you say you need eligibility and benefits and the benefits is gonna be for a sleep study?
[CUSTOMER][NEUTRAL] The benefit is for E0601 so.
[AGENT][NEUTRAL] For what? I'm sorry?
[CUSTOMER][NEUTRAL] This is for
[CUSTOMER][NEUTRAL] CPAP machine.
[AGENT][NEUTRAL] Oh, dear me, OK.
[AGENT][NEUTRAL] Alright, let me check her benefits and see if it's covered under this policy. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer, Mr. [PII].
[AGENT][NEUTRAL] And it's gonna be a minute. I'm waiting on the certificate information for the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. If this is a medical supplement plan, please let me know.
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] So this is a supplemental plan.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK, let me change my note. I think it's.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so just quite mean effective date for this plan.
[AGENT][NEUTRAL] All right, and.
[AGENT][NEUTRAL] OK. Effective date is [PII]. It is active at the moment.
[CUSTOMER][NEUTRAL] And what's the plan type? It's a supplemental plan FG or like what's that?
[AGENT][NEUTRAL] It's not a Medicare plan. This is a secondary supplemental plan to the major medical, to any major medical.
[CUSTOMER][NEUTRAL] So what does it mean? Plan, what's the plan? Does the policy cover Medicare part deductible if Medicare is primary?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] I it's not Medicare, no, this is not for Medicare or Medicaid or anything like that. This is for a major medical plan, um, basically like Aetna, Blue Cross, Cigna, um, United, um, any of those.
[AGENT][NEUTRAL] In this case, let me see which one she has.
[CUSTOMER][NEUTRAL] But you told me that this is a medical, but you told me that this is a medical supplement plan.
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] It is a supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] So I know about that. It's uh the primary is the BCBS and the secondary is American Public Life. So I need to check what's the, what's the plan type. It's plan GFHN. What's that?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] There's no letters, Mr. [PII]. This is not a Medicare or Medicaid plan.
[AGENT][NEUTRAL] So there's no letters.
[CUSTOMER][NEUTRAL] OK. Does the policy cover co-insurance left from the primary?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. Does the policy cover Medicare Part B deductible if
[AGENT][NEUTRAL] This is not Medicare or Medicaid again. Mm mm, no.
[CUSTOMER][NEUTRAL] BCBS of like me.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So what the coverage for this plan?
[AGENT][NEUTRAL] OK, so this is a secondary to help with the major medical deductible co-payment and co-insurance. It does have doable medical equipment, and we do not cover disposable supplies. We do cover the um equipment, and this is subject to the outpatient maximum which is a combined benefit of $5000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] What's the benefit for this? This is cover 100%. No patient responsibility.
[AGENT][NEUTRAL] Again, we're not the major medical, we're the secondary, so we help. OK, let me give you an example, OK? If the major medical process the claim and it's for the CPAP machine and they are asking for $500 they apply those $500 to the deductible of the policy.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] That, that's gonna go to the deductible and it's gonna be on the member's responsibility. That is the amount that we're gonna be looking into to pay the $500 that is applied towards the deductible of the major medical, and that's what we're gonna pay.
[AGENT][NEUTRAL] Now, the benefit maximum for the whole year is 5000.
[CUSTOMER][NEUTRAL] So means you will
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But as I know about that, in the Medicare supplement plan, there is no deductible, no out of pocket, and the plan will cover 100%.
[AGENT][NEUTRAL] We'll cover up to $5000. I cannot tell you we'll cover the full amount.
[AGENT][NEUTRAL] We cover up to $5000 per calendar year.
[CUSTOMER][NEUTRAL] And what's the co-insurance?
[AGENT][NEUTRAL] There's no coinsurance, there is no deductibles, co-payment, and coinsurance with us. We help with the deductibles, co-payment, and co-insurance from the major medical.
[CUSTOMER][NEUTRAL] Is alteration required?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] What's the timely filing limit?
[AGENT][NEUTRAL] We don't have timely time limits.
[CUSTOMER][NEUTRAL] OK. What's the payer ID?
[AGENT][NEUTRAL] OK, the payer ID is 60801. Now this claim needs to be faxed or mailed because we need the copy of the explanation of benefits attached to it.
[CUSTOMER][NEUTRAL] OK. May I know your name and the first initial of the last name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, do you follow the Medicare guidelines?
[AGENT][NEUTRAL] I guess we do. um, we're not Medicare, but yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But I just ask, do you follow Medicare guidelines?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So you follow Medicare guidelines.
[AGENT][NEUTRAL] I guess you do.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah, I just ask, do you follow Medicare guidelines?
[AGENT][NEUTRAL] OK, Mr. [PII], we're not related to Medicare or Medicare, Medicaid, Medicaid, we don't, we don't work with that. We are a secondary supplemental commercial plan.
[CUSTOMER][NEUTRAL] OK, what's the card number?
[AGENT][NEUTRAL] My name and today's date we don't have reference numbers.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome, is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No.