AccountId: 011433970860
ContactId: c52114c7-d91b-48a8-89b2-8a91c5fb71a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420980 ms
Total Talk Time (AGENT): 156930 ms
Total Talk Time (CUSTOMER): 201689 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/c52114c7-d91b-48a8-89b2-8a91c5fb71a9_20250619T14:52_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. Um, this is [PII]. I'm calling, um, I'm hoping I'm in the right uh department um for benefits and eligibility and a member.
[AGENT][NEUTRAL] Yes, I can help with benefit eligibility. What's that policy number, please?
[CUSTOMER][NEUTRAL] 02567750
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] Thank you. Is there um a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. You mentioned benefits. This is a secondary or gap insurance that's meant to pick up the deductible.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Co-payment or co-insurance from the major medical?
[AGENT][NEUTRAL] Um, would you like benefits for the outpatient hospital or for treatment within a physician's office, uh, independent lab, durable medical?
[CUSTOMER][NEUTRAL] Um, this is actually.
[CUSTOMER][NEUTRAL] Uh-huh, well, it's for home infusion. So, um, it's home infusion benefits.
[AGENT][NEUTRAL] OK. I don't believe this policy has benefits for home infusion. Now, there is a, a durable medical policy. Um, if there is a medical equipment, durable medical equipment that is covered.
[AGENT][NEUTRAL] That, uh, not home, not home treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, policy does not.
[CUSTOMER][NEUTRAL] Uh, home.
[CUSTOMER][NEUTRAL] Confusion.
[CUSTOMER][NEUTRAL] Only DME. OK. Um, OK, um, so is this considered like a secondary to Blue Cross to Blue Cross? I think the patient has Blue Cross.
[AGENT][POSITIVE] Yeah, that's exactly what it is.
[AGENT][NEUTRAL] Yeah, the secondary entrance.
[CUSTOMER][NEUTRAL] But um OK. Secondary, so this is a secondary to Blue Cross. You, you're showing primary Blue Cross for her?
[AGENT][NEUTRAL] Uh, let's see. I believe I do, um.
[AGENT][POSITIVE] What I have for her is uh Blue Cross and Blue Shield. That is correct.
[CUSTOMER][NEUTRAL] Mhm. OK. So, again, this patient is being referred for us for um home infusion benefit, um, home infusion, um.
[CUSTOMER][NEUTRAL] Therapy. It can be done at the infusion seat or home, um.
[CUSTOMER][NEUTRAL] So if, if Blue Cross pays, would you all pick up or no?
[AGENT][NEUTRAL] Well, it's, it, it's not, not if it's in a physician's office, if it's in a hospital setting, the home treatment is not covered. So if, if it's listed as home treatment, then it would not be covered.
[CUSTOMER][NEUTRAL] OK, if listed as.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Will not.
[CUSTOMER][NEUTRAL] Cover, OK. OK, can you provide me with those DME benefits, please?
[AGENT][NEUTRAL] Yes, as I, as I mentioned before, there's outpatient services, and so what they will do is we will pick up the deductible, co-payment or co-insurance for outpatient services up to $5000 per calendar year. That's just a verification. The benefit is not a guarantee of payment, and it looks like for the calendar year [PII], I'm just checking that, uh, it looks like, um, uh.
[AGENT][NEUTRAL] It looks like about $2000 of those benefits have been.
[CUSTOMER][NEUTRAL] OK, so this, this policy has a deductible of $5000.
[AGENT][NEUTRAL] No, no, it pays up to $5000. That, that's the benefit. There's no deductible on the. So what we do is we pick up the deductible co-payment of coin insurance from Blue Cross and Blue Shield.
[CUSTOMER][NEUTRAL] Oh, it pays.
[AGENT][NEUTRAL] But there's no deductible. There's no additional deductible on deductible on this policy.
[CUSTOMER][NEUTRAL] OK, OK, so let me see if I'm understanding. I'm sorry, [PII]. OK, yes, um, Blue Cross Blue Shield has a deductible of $5000 so you all pick up.
[CUSTOMER][NEUTRAL] Blue Cross deductible up to $5000 is that what you're, you're, is that, is that my understanding?
[AGENT][POSITIVE] Yes, the, the deductible, co-payment or co-insurance. That is right. That is exactly right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. Well, their, their, their current co-insurance or the out of pocket is $7000. But you only, you all cover up to $5000.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, OK, this, OK.
[CUSTOMER][NEUTRAL] Only cover.
[CUSTOMER][NEUTRAL] 25,000.
[CUSTOMER][NEUTRAL] Per per calendar year? or you just, it's based on per calendar year?
[AGENT][NEUTRAL] For a calendar year
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Of course, excluding home, um, home treatments, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And you said the policy effective is uh [PII] and it's currently active. Uh what is the mailing address for claims?
[AGENT][NEUTRAL] Our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] Our zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] OK, is there a um electronic payer ID?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] That is correct, 60801.
[CUSTOMER][NEUTRAL] OK, and what is the timely uh filing?
[AGENT][NEGATIVE] There's no timely filing on these on these planes because we're the secondary.
[CUSTOMER][NEUTRAL] Time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] Is there anything else at all I can help with, [PII]?
[CUSTOMER][NEUTRAL] No, just, just first name first initial with the last name [PII] and a reference call number if you can provide it.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Yes, it's K as [PII] kite. We're gonna use that today's date as our reference.
[CUSTOMER][NEUTRAL] OK, date and time.
[CUSTOMER][POSITIVE] Thank you, ma'am. Have a great day.
[AGENT][POSITIVE] OK, thank you for contacting UT have a good day.