AccountId: 011433970860
ContactId: bc89799e-6805-4b6c-8e30-93e206f15d7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 560239 ms
Total Talk Time (AGENT): 217586 ms
Total Talk Time (CUSTOMER): 126224 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/bc89799e-6805-4b6c-8e30-93e206f15d7c_20250303T17:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is.
[AGENT][NEUTRAL] [PII], how may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII] I'm calling because I have a couple of questions in regards to a few claims.
[AGENT][NEUTRAL] OK, I can help you with claim status. uh, [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] So it's myself, uh [PII] My last name is [PII] My date of birth is [PII]. I'm sorry, what was the last question?
[AGENT][NEUTRAL] OK, and then what is your policy number, [PII]?
[CUSTOMER][NEUTRAL] Uh, policy number, um.
[CUSTOMER][NEUTRAL] Let me pull that up for you.
[CUSTOMER][NEUTRAL] Policy number is going to be 236.
[CUSTOMER][NEUTRAL] 1422.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, and for security reasons can you please verify your address?
[AGENT][NEUTRAL] For
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] All the all the.
[AGENT][NEUTRAL] OK, and what is your email address please?
[CUSTOMER][NEUTRAL] My first name, the letter [PII].
[AGENT][POSITIVE] OK thank you so much and the number.
[AGENT][NEUTRAL] That you gave me uh earlier is that a good number to call back on if we get disconnected?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK perfect thank you so much. How can I help you?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, I'm calling because I, I have a couple of questions. So, from my understanding, this, uh, plan does cover for DME supplies, but one of the DME supplies I'm receiving is ran under my pharmacy. Would it still be covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um let me pull up your policy real quick and view what it says about the.
[AGENT][NEUTRAL] DME
[AGENT][NEUTRAL] And we'll read over it together.
[AGENT][NEUTRAL] It's gonna be just a second while the computer pulls in your policy.
[CUSTOMER][POSITIVE] Yeah, no rush, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I haven't forgot about you. I'm searching for it.
[CUSTOMER][POSITIVE] Yeah, no rush, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's look for the writer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so this is what it says about durable medical equipment for you. Um.
[AGENT][POSITIVE] You have a you do, you're right. You do have a durable medical equipment rider.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] Um, and the benefits are in accordance with the schedule of benefits and after satisfaction of any certificate deductible shown on this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Schedule of benefits, we will pay the charges incurred by a covered person under the other medical plan, meaning your primary insurance. The covered person must be covered by the primary insurance plan at this at the time that such charges are incurred, and then durable medical equipment is we will pay out of pocket amount incurred by the durable medical equipment when recommended by the physician and covered by your primary insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK, but the que the the more specific question?
[AGENT][NEUTRAL] Um, benefits are limited to the maximum.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, no, I'm sorry, go ahead.
[AGENT][NEUTRAL] So your benefits are limited to the outpatient benefits, so it falls under your outpatient benefit.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] It's on your schedule of benefits.
[CUSTOMER][NEUTRAL] OK, now I think that the question is a little bit more specific. It's, I understand that the DME supplies are covered, um, but for, for this specific DME supply, my insurance is running it under pharmacy benefits instead of medical so I just wanted to verify if.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It would still be covered.
[AGENT][NEUTRAL] Right, so this falls underneath your outpatient benefits and your outpatient benefits. Um, let me see if you have any pharmacy at all on this plan.
[AGENT][NEGATIVE] You do not have pharmacy benefits on this plan.
[AGENT][NEUTRAL] So it would be covered under, it would be under your outpatient benefit and this is just to verify your benefits it's not a guarantee of payment you have an outpatient benefit per calendar year of $3000.
[AGENT][NEUTRAL] So let me check one thing real quick, make sure office visits are covered under your policy.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] I do not see any.
[AGENT][NEUTRAL] Pharmacy underneath your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you would
[AGENT][NEUTRAL] You would need to get it as an outpatient.
[AGENT][NEUTRAL] Facility at an outpatient facility rather than a pharmacy um.
[AGENT][NEUTRAL] And that would be like an ER urgent care center MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] Right, right. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, perfect, and then I do have one more question in regards to independent lab test, same thing applies.
[AGENT][NEUTRAL] All right. Oh.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Yes, a lab, uh, independent lab facility. That would be, uh, also a ER urgent care center, MRI imaging center, and ambulatory center.
[CUSTOMER][POSITIVE] Perfect. OK, that was all the information I needed for today. Thank you so much. I do appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Well, you're so welcome, [PII]. I hope you have a great rest of your week and we thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you likewise bye bye.
[AGENT][NEUTRAL] Bye bye.