AccountId: 011433970860
ContactId: bcc2b366-c348-4257-b330-1f68c9859328
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299760 ms
Total Talk Time (AGENT): 126572 ms
Total Talk Time (CUSTOMER): 103740 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/bcc2b366-c348-4257-b330-1f68c9859328_20250217T20:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and this call is regarding to verify eligibility and benefits. So could you please help me with that?
[AGENT][NEUTRAL] Sure, I can verify benefits and eligibility for you and your name again?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] 01792127.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me a moment and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The patient name is [PII]'s date of birth, [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] You say you're calling to verify benefits and eligibility, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm showing an effective date of [PII] policy is active and what benefits are you needing for this patient?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What's the plan type?
[AGENT][NEUTRAL] It's a secondary supplemental policy.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Could you please help me with the benefits? I have one CPT code. The code that I have is E0601.
[AGENT][NEUTRAL] Is this gonna be in an outpatient facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is that code again?
[CUSTOMER][NEUTRAL] E Echo 0601. This is for DME CPAP machine.
[AGENT][NEUTRAL] OK. DME is covered under the policy. It's outpatient, not a guarantee of payment, just verification of coverage. With this policy is secondary, we help with primary insurance deductible, co-pay, and or co-insurance, and the patient has benefit max of up to $5000 per calendar year.
[CUSTOMER][NEUTRAL] One second. Could you please repeat it again?
[AGENT][NEUTRAL] Not a guarantee of payment, just a verification of coverage. With this policy is secondary, we help with primary insurance deductible, co-pay, and or co-insurance, and the patient has a benefit max up to $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK, and uh how much is it satisfied or not?
[AGENT][NEUTRAL] So far they haven't used any benefits for this year, so it is available.
[CUSTOMER][NEUTRAL] OK, so this is the secondary plan and pay 100% left by the primary, right?
[AGENT][NEUTRAL] Uh, we only pick up what they apply for deductible, co-pay, or co-insurance up to the $5000 benefit max.
[CUSTOMER][NEUTRAL] OK. And what after, once the $5000 has been met then?
[AGENT][NEGATIVE] Once they've met the $5000 benefit and they don't have any benefits uh remaining for that calendar year.
[CUSTOMER][NEUTRAL] OK, that, uh, that means, uh, when the patient has me out of pocket of $5000 then
[CUSTOMER][NEUTRAL] This insurance will no longer applies, right? I mean, patient needs to pay.
[AGENT][NEUTRAL] For that calendar year.
[CUSTOMER][NEUTRAL] Yeah, patient needs to pay the coinsurance left by the primary, right?
[AGENT][NEUTRAL] It would be their responsibility. The policy only picks up up to that $5000. Once that $5000 is met, then there's no more benefits payable for that calendar year.
[CUSTOMER][NEUTRAL] $5000.
[CUSTOMER][NEUTRAL] OK, got it. And uh is there any, can you check the billing history?
[AGENT][NEGATIVE] They have not used any benefits here.
[CUSTOMER][NEUTRAL] Or we need to call primary.
[CUSTOMER][NEUTRAL] OK. OK. OK. Can you please spell your name for me?
[AGENT][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] OK, and can I have the electronic payer ID for claims?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, and the timely filing limit for claims?
[AGENT][NEUTRAL] Uh, there's no time limit.
[CUSTOMER][NEUTRAL] OK, primary will cross over the claim. OK. Can I have the card number at the end?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use by name of today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much and have a great day bye bye.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL, Tom, bye.
[CUSTOMER][NEUTRAL] Mm bye.