AccountId: 011433970860
ContactId: b3a3b6d5-cf48-4575-be64-5ec0cd7eeec8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 638760 ms
Total Talk Time (AGENT): 239973 ms
Total Talk Time (CUSTOMER): 261927 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/b3a3b6d5-cf48-4575-be64-5ec0cd7eeec8_20250425T17:34_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, good afternoon, [PII]. My name is [PII]. I'm calling from Marai Associates. I'm calling to check on um.
[CUSTOMER][NEUTRAL] Uh, uh, benefits and eligibility for a member.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I'll be more than happy to help you with the eligibility and benefits and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, the phone number is [PII] my [PII], what am I seeing?
[CUSTOMER][NEUTRAL] I forgot to tell you [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you and the member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] 47, 2, 3227 ML 7.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You don't need date of date of birth, right?
[AGENT][NEUTRAL] And can you
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh you do? I'm, I'm waiting on that information. I can tell you his name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's, it's [PII].
[AGENT][NEUTRAL] OK, and then the date of birth whenever you have it.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Yeah, I'm waiting.
[AGENT][NEUTRAL] Um, can you verify the
[CUSTOMER][POSITIVE] I can give you the group.
[AGENT][NEUTRAL] Um, can you verify the last four digits of your social?
[CUSTOMER][NEUTRAL] Oh my [PII], I'm waiting on.
[AGENT][NEUTRAL] Oh, like you're waiting on all his demographics?
[CUSTOMER][NEUTRAL] Can I place you on a?
[CUSTOMER][NEUTRAL] Yeah, I'm waiting on his um date of birth.
[CUSTOMER][NEUTRAL] Can I place you on a brief hold please?
[AGENT][NEUTRAL] Sure. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you for calling MedEye Associates serving South Florida with comprehensive ophthalmology care since [PII]. We can help with glaucoma, cataracts, and retina issues, and our highly skilled surgeons use cutting edge technology for exceptional results, including LASIK and Lenzar. Assistance is just a moment away.
[CUSTOMER][NEUTRAL] Mediy Associates has grown considerably over the years. Our main office is at [PII]. OK, hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Thank you for waiting. His date of birth is [PII].
[AGENT][POSITIVE] Oh you're welcome.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing that the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] We, um, so we wanna know about hospital copays, deductible.
[CUSTOMER][NEUTRAL] Um, and for MRI please.
[AGENT][NEUTRAL] OK, so this is the member's secondary policy. So we applied to the co-pay, deductible and co-insurance of coverage charges after his primary insurance, which is Florida Blue.
[AGENT][NEUTRAL] So there's no um
[AGENT][NEUTRAL] We apply to those things if Florida Blue charges it, um, like if they are required to pay a co-pay or a deductible to be seen, then once the claim, they'll have to pay it upfront, and then once the claim is um submitted for billing, they could be reimbursed or something is owed to you, it could be paid to you.
[CUSTOMER][NEUTRAL] OK, um, do you, do you mind faxing over his benefits?
[CUSTOMER][NEUTRAL] Um, information because we wanna, we would like to send this patient to have an MRI, but we, we're checking on the primary and we're making sure that he's covered with the secondary you guys are.
[AGENT][NEUTRAL] Do you want me to
[AGENT][NEUTRAL] Do you want me to tell you the benefits for the secondary policy? I was just letting you know we don't apply a co-pay.
[AGENT][NEUTRAL] We help pay it.
[CUSTOMER][NEUTRAL] No, I know you, you guys help pay. That's what I wanna know if you guys help to pay the copay, the deductible, like, um, and the MRI if he should be sent for an MRI and the primary applies a deductible or co-pay if you guys.
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] Let's pick that up.
[AGENT][NEUTRAL] So the calendar year max for the outpatient expenses um is $2500.
[AGENT][NEUTRAL] That does include
[CUSTOMER][NEUTRAL] A day?
[AGENT][NEUTRAL] No, per calendar year.
[CUSTOMER][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] It's 2500 which he hasn't.
[AGENT][NEUTRAL] Do you want me to see if he's used any?
[CUSTOMER][NEGATIVE] Exhausted
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, so for [PII], he hasn't used any of his outpatient benefits.
[CUSTOMER][NEUTRAL] He has not.
[CUSTOMER][NEUTRAL] Outpatient benefit is 2500. He has not exhausted. He has not touched it as yet.
[AGENT][NEUTRAL] Right, he has the full balance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And does he have per day benefits or just per calendar?
[AGENT][NEUTRAL] No, this is the calendar year policy.
[CUSTOMER][NEUTRAL] OK, ours is completely different. OK, what else do you mind faxing me over the benefits, please?
[AGENT][NEUTRAL] Um, we don't send over medical benefits.
[CUSTOMER][NEUTRAL] You guys don't fax those information?
[AGENT][NEUTRAL] No, only for dental.
[CUSTOMER][NEUTRAL] Oh my god, I'm trying to, I'm trying to get an, I'm trying to get one more information from.
[CUSTOMER][NEUTRAL] But I guess I have to call back for that.
[AGENT][NEUTRAL] I mean, what else did you want to go over?
[CUSTOMER][NEUTRAL] Like he, he wants to know.
[CUSTOMER][NEUTRAL] You're basically telling me everything because he wants to know if hospital copays and deductible is covered under a secondary like when his primary process copay and or deductible for the hospital, do you guys kick in and pay that for him?
[AGENT][NEUTRAL] Right, so that's what I was explaining in the beginning. So if he has to pay something like that, he, he will be, it depends on the provider. If it's a provider that's going to require him to pay to be seen, then he needs to pay that upfront, and then once the claims are filed, primary will apply and then it will come to us to apply after primary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we'll either reimburse him for whatever he paid towards that from that $2500 or we'll pay it to you if it's something that was billed.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, I, I understand that because I have APL too and I have to do the same thing. So if he pays out of pocket, he has to submit his own claim.
[AGENT][NEGATIVE] No, he's, he's going to prevent.
[CUSTOMER][NEUTRAL] Cause how, cause if the, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Receipt.
[AGENT][NEUTRAL] He's going to submit his ID card to the provider, just like when he gives his Florida Blue card, he's going to give the APL card. They're going to bill Florida Blue and then they're going to bill us.
[AGENT][NEUTRAL] He, he, I mean, he has the option to if he'd like to file the claim, but typically the provider files the claim.
[CUSTOMER][NEUTRAL] No, I understand that part, but what if it's a oh, OK, I have to mention his primary is not Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] His primary is admin.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Wait, he has to call to update that I I'm just getting the information right now as I'm speaking to you, so I'm gonna have to let him know.
[AGENT][NEUTRAL] Well, this policy is through his, hold on, this policy is through his employer. This, this APL policy is through his employer. This APL policy is second only to Florida Blue.
[AGENT][NEUTRAL] If he has other insurance, he can have other insurance, but this policy, and I'll double-check it. Hold on one moment.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's second only to [PII] Blue.
[CUSTOMER][NEUTRAL] OK, I'm, I'm relaying the information as we speak, um, I guess I'll have to call back when I get all the information.
[AGENT][NEUTRAL] I'm not
[AGENT][NEUTRAL] Right, I'm not denying that he doesn't have other insurance. I'm just letting you know primary, secondary, this is only 2nd to [PII] Blue. He can have 3 insurances for, but I'm just letting you know this APL policy is only 2nd to [PII] Blue, so he may have admin also.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] Yeah, but I'm being told that his [PII] Blue is no longer Amid. I mean, no, no longer um [PII], they switched it to Amed.
[AGENT][NEUTRAL] OK, um, well, if that's the case, then his employer is going to have to notify us that it's no longer [PII].
[AGENT][NEUTRAL] But as of today in our system, it shows as [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, um thank you so much for your information. Do you give um call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and that's [PII] The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you [PII], I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] Alright, thanks for calling APO bye bye.
[CUSTOMER][NEUTRAL] Bye.