AccountId: 011433970860
ContactId: c1d9108e-2ba6-4e00-9ff8-f89dc2980280
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 504359 ms
Total Talk Time (AGENT): 70347 ms
Total Talk Time (CUSTOMER): 115255 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/c1d9108e-2ba6-4e00-9ff8-f89dc2980280_20250605T19:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon and thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], calling on behalf of the Amgen Support Plus program on a recorded line for training and quality assurance. I'm calling to verify medical benefits for patient [PII], who is a mutual patient of Dr. [PII].
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call?
[CUSTOMER][NEUTRAL] I'm calling to verify benefits for Prolia with code J0897 and admin code 96372 for diagnosis code M81.0 administered in a specialist office. But first, do you have any questions about the patient or provider for me? My direct callback number is [PII]. No extension is required.
[AGENT][NEUTRAL] Do you have the policy number?
[CUSTOMER][NEUTRAL] The patient's ID number is 01936871.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] Patient's first name [PII], last name [PII].
[AGENT][NEUTRAL] And the patient's date of birth?
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you were wanting benefits?
[CUSTOMER][NEUTRAL] Could you spell out your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] What is the policy effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is the plan active?
[AGENT][POSITIVE] Yes, it is active.
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment.
[CUSTOMER][NEUTRAL] What is the plan name?
[AGENT][NEUTRAL] Medlink.
[CUSTOMER][NEUTRAL] Can you spell that, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] What type of plan is this?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is it a PPO, POS, or HMO plan?
[AGENT][NEUTRAL] Neither.
[AGENT][NEUTRAL] The secondary policy.
[CUSTOMER][NEUTRAL] Is this an indemnity plan?
[AGENT][NEUTRAL] It's a secondary policy that coordinates with the primary.
[CUSTOMER][NEUTRAL] What type of plan is this?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is this an employer group Medicare plan?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Is there a standard plan letter for this patient's supplemental plan?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Just a moment, please.
[CUSTOMER][NEUTRAL] Is this a commercial or Medicare Advantage plan?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Which one, Medicaid, Medicare, or Tricare?
[AGENT][NEUTRAL] Neither none.
[CUSTOMER][NEUTRAL] For billing purposes, what is the group number?
[AGENT][NEUTRAL] 12696.
[CUSTOMER][NEUTRAL] What is the group name?
[AGENT][NEUTRAL] City of Elektra.
[CUSTOMER][NEUTRAL] Does this run on benefit or calendar year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Is this plan self-funded or fully insured?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Is this plan self-funded or fully insured?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Is a referral required from the primary care physician to see a specialist?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Our records indicate that this member has another insurance policy. What is the name of the other insurance?
[AGENT][NEUTRAL] I do not know.
[CUSTOMER][NEUTRAL] Can I have a reference number, please?
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thanks so much for your help today. Have a great day. Bye.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You too.
[AGENT][NEUTRAL] Bye bye.