AccountId: 011433970860
ContactId: bbc3d3c8-1da8-47f5-bf50-77ad0ea1f3b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456250 ms
Total Talk Time (AGENT): 190981 ms
Total Talk Time (CUSTOMER): 150556 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/bbc3d3c8-1da8-47f5-bf50-77ad0ea1f3b0_20250421T18:22_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] Uh, yes, I'm calling from a doctor's office. I was just trying to get benefits on a patient.
[AGENT][POSITIVE] OK, well, I can definitely help you with the benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII].
[CUSTOMER][NEUTRAL] Phone number is [PII] and there's no extension.
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] That is, well I have the certificate number or a group number?
[AGENT][NEUTRAL] Yes, the certificate number is the policy number.
[CUSTOMER][NEUTRAL] OK, that's 0222.
[CUSTOMER][NEUTRAL] 165.
[CUSTOMER][NEUTRAL] 7 ML
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] That's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. I am showing that the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][POSITIVE] Uh, we're gonna be, um, giving the patient a piece of durable medical equipment for the treatment of sleep apnea. Um, and I noticed that United, they have United as primary, and I was just seeing how this plan would pay in the secondary if we needed to get um pre-certification and whatnot.
[AGENT][NEUTRAL] OK. Uh, so this policy pays towards the copay, deductible and co-insurance of covered charges after primary. Um, durable medical equipment is under outpatient, so that benefit is up to $3500 per calendar year per person.
[AGENT][NEUTRAL] Um, did you want me to see if any of that Max has been used for this year?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so none of the benefits have been used for this year, so he still has the full 3500 to use towards the durable medical equipment. Let me see if it has, hold on one second.
[AGENT][NEUTRAL] A minute.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sometimes the, I'm trying to see if they have uh like requirements. Hold on one second, child.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if it does it here.
[AGENT][NEGATIVE] Um, it just needs to, it cannot be disposable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It has to be covered by the other plan.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] Um, let me see what else it says it is not useful.
[AGENT][MIXED] Everything else kind of is durable medical equipment like it has to be used in the home, that type of thing, but the biggest thing is it can't be disposable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so for the most part if primary approves, then this plan would approve as well.
[AGENT][NEUTRAL] For the most part, yes.
[CUSTOMER][NEUTRAL] OK, and then, um, there's no coordination of benefits on file with uh United, so when we, when we submit a claim, will we just submit United's ELB with the claim to you guys?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, you will be and the um
[AGENT][NEUTRAL] Y'all's claim form or itemized bill.
[CUSTOMER][NEUTRAL] OK. And uh is there um a fax number or claims mailing address?
[AGENT][NEUTRAL] Sure. Uh, we have both and a payer ID. Um, would you like all three, or you have a particular?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'll take, I'll take all three.
[AGENT][NEUTRAL] OK, so our claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the um, OK, so that's the mailing address. The fax number is um [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's attention APL claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] APL please.
[AGENT][NEUTRAL] And then the payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And then, um, so this patient, they have um a $5000 deductible from United that they have net $0 towards, um, if it approved, um, would it all that all $3500 of that DME would be applied to the deductible is that we're, um, assuming.
[AGENT][NEUTRAL] Well, we can't really, I can't really guarantee that until we get the paperwork, um, because I don't know how everything is gonna come in, but
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, it could be
[CUSTOMER][NEGATIVE] So it might not approve the full 35.
[AGENT][NEUTRAL] Well, no, no, that's not what I'm saying. I'm saying I don't know if the full 35 will go to just that if there's other charges and they put some to that and some to the other charges, I'm not sure. Um, but based, you know, between the two, the, the deductible and the charges, the $3500 unless other claims come in and deduct that.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] could be applied.
[CUSTOMER][NEUTRAL] OK, alright, I'll just, I was just to kind of give patient. I don't know if they understand how their, their claim works or not or how their plan works. So I was just trying to give them a little vague, um, you know, obviously everything is gonna be dependent on what gets approved, but I'll, I'll explain to them that they have a $3500 DME max and we'll see how much gets applied to the uh United deductible when everything uh goes through.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. And then um thank you for your help. What was your name again?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And the first initials of my last name is [PII].
[CUSTOMER][NEUTRAL] And is there a reference number for our call?
[AGENT][NEUTRAL] Um, there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] All right, [PII], thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL call. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] All right, well, I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.