AccountId: 011433970860
ContactId: c0515bca-a56f-488b-b904-2e0f53b55acc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578239 ms
Total Talk Time (AGENT): 171074 ms
Total Talk Time (CUSTOMER): 140682 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/c0515bca-a56f-488b-b904-2e0f53b55acc_20250124T13:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. It is my last name [PII]. I'm calling on a recorded line for quality and training purpose for Doctor [PII], and I need to obtain medical benefits and eligibility for our patient.
[AGENT][POSITIVE] OK. Well, I'll be more than happy to assist you with the eligibility and benefits. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. Well,
[CUSTOMER][NEUTRAL] That will be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Well, it is 01852130, M as in Mike, L as in Lima, the number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, the member's name is [PII], and date of birth, [PII].
[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 the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what is a good, um, or I'm sorry, what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Well, uh, one second.
[CUSTOMER][NEUTRAL] I need to obtain coverage information specific to medication [PII] first, I would like to confirm some plan eligibility information.
[AGENT][NEUTRAL] OK. I don't understand. You said you're needing some information on medication. Like what type of benefits are you needing to go over?
[CUSTOMER][NEUTRAL] Just one moment.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting. Uh, it is, um, about injection.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is your facility inpatient or outpatient?
[CUSTOMER][NEUTRAL] It's occupation.
[AGENT][NEUTRAL] OK, so the policy is broken down into facility, not so much the service that's getting done. For outpatients, the policy will pay up to $7000 per calendar year. The patient also has the office treatment rider in which any um services done in the office as long as it's not cosmetic could be covered up to that $7000 per calendar year.
[AGENT][NEUTRAL] She does also have the independent lab rider. So if it was for a place like Labor or Quest Diagnostic, there's uh coverage for that treatment also up to the 7000 per calendar year.
[AGENT][POSITIVE] And there's durable medical equipment coverage as well.
[CUSTOMER][POSITIVE] Thank you so much. Um,
[CUSTOMER][NEUTRAL] May I know whether the policy runs on a plan year or calendar year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Thank you. And are you secondary for Medicare?
[AGENT][NEUTRAL] No, um, our plan is second only to, hold on one moment.
[AGENT][NEUTRAL] United Healthcare.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] OK, thank you so much and
[CUSTOMER][NEUTRAL] Can I know the specific plan name?
[AGENT][NEUTRAL] Yes, this is the Medlink supplemental gap insurance.
[CUSTOMER][NEUTRAL] May I know, is it uh
[CUSTOMER][NEUTRAL] The plan name like alphabetic plan name like Plan A, Plan B, Plan G. Is there any alphabetic plan name?
[AGENT][NEUTRAL] This is not in relation to Medicare or major insurance. This is a secondary insurance. It's a Medlink, M E D L I N K.
[AGENT][NEUTRAL] Supplemental gap insurance policy.
[CUSTOMER][NEUTRAL] May I know, is it a non-standard supplement or a standard supplement?
[AGENT][NEUTRAL] It's a standard supplement.
[CUSTOMER][NEUTRAL] Standard supplement. OK. One moment.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting. Well, uh,
[CUSTOMER][NEUTRAL] Just for checking in the previous case here, uh, in my end.
[CUSTOMER][NEUTRAL] Well, it is a non-standard supplement plan, so can you clarify?
[CUSTOMER][NEUTRAL] Could you please double check again?
[AGENT][NEUTRAL] Sir, what are you trying to obtain?
[AGENT][NEUTRAL] What's the information you're trying to obtain? I can try to help you. I don't, the answer to your question is it's a standard supplemental gap insurance. It's not in relation to Medicare or Medicaid. It's second only to UnitedHealthcare. We pay towards the copay, deductible and co-insurance after coverage charges.
[AGENT][NEUTRAL] And after primary.
[CUSTOMER][NEUTRAL] Just one moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting. Well, so for as standard, is it uh the plan which cover the remaining Part B, deductible and co-insurance?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Does it cover the remaining Part B deductible and co-insurance?
[AGENT][NEUTRAL] Part B to what? Medicare?
[AGENT][NEUTRAL] This policy again is only 2nd to the United Healthcare policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Only.
[AGENT][NEUTRAL] And we pay towards the copay, the deductible and co-insurance of coverage charges after their primary UnitedHealthcare. So we're not in relation to Part A, B, C, that's Medicare. This is only to UnitedHealthcare.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, just one moment please.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So you're not related with Medicare, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just one moment.
[CUSTOMER][POSITIVE] OK. Well, thank you so much. Um thank you so much for patiently waiting. Well, um,
[CUSTOMER][NEUTRAL] Can, can you please spell out your name and can I have your reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name, which is [PII] The first initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Well, no, thank you so much. Fine.
[AGENT][POSITIVE] You're welcome. Thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.
[AGENT][NEUTRAL] Bye bye.