AccountId: 011433970860
ContactId: c63a85b8-9ce3-4e8d-9043-8153d73500fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319709 ms
Total Talk Time (AGENT): 129163 ms
Total Talk Time (CUSTOMER): 92983 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/c63a85b8-9ce3-4e8d-9043-8153d73500fc_20250103T15:35_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and this call is for benefits and eligibility.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits and eligibility. What is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you sir and what is the patient's name?
[CUSTOMER][NEUTRAL] The patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, and patients policy number please?
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 65613.
[AGENT][NEUTRAL] OK, let me look that up for you real quick.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. His effective date is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And this is just to verify benefits it's not a guarantee of payment. This is a supplemental insurance policy that's secondary to the primary. It helps with deductible, co-pay and co-insurance. He has an inpatient calendar year benefit amount of $2000 and an outpatient calendar year benefit amount of $2000.
[CUSTOMER][NEUTRAL] Uh, I just have a query. Is there any alphabet for plan type, like it's a plan G and F or something?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It it's just the Medicare supplement plan.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, then
[CUSTOMER][NEUTRAL] What's the plan type of this patient?
[AGENT][NEUTRAL] It's a supplemental insurance policy that helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] So there is deductible and co-insurance as well.
[AGENT][POSITIVE] It helps with that no deductible or co-insurance on this policy. It helps to pay for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK. I just only have two questions. Does the policy cover the Part B deductible?
[AGENT][NEUTRAL] Does it cover what, sir?
[CUSTOMER][NEUTRAL] Part B deductible.
[AGENT][NEUTRAL] This policy is not a supplement for
[AGENT][NEUTRAL] Care. It's a standalone policy that's billed after the primary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what's the deductible amount you say is $2000.
[AGENT][NEUTRAL] He has patient benefit amount of $2000 per calendar year and he also has outpatient benefit amount of $2000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please tell me the
[CUSTOMER][NEUTRAL] Effective date of the plan is
[AGENT][NEUTRAL] The effective date is.
[CUSTOMER][NEUTRAL] Was
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you also check if pre-authorization is required or not?
[AGENT][NEUTRAL] If that, what is, sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I have 2 CPT codes. Can you check that if pre-authorization is required for those codes or not?
[AGENT][NEUTRAL] The pre-authorization is not required on this policy.
[CUSTOMER][NEUTRAL] OK. Can you please tell me the payer ID?
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][NEUTRAL] And, and the timely filing limit to submit the claim.
[AGENT][NEGATIVE] There's not a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's the secondary insurance.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Yes, yes, gap insurance, secondary gap that helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh what's your first name and the initial of your last name?
[AGENT][NEUTRAL] My first name is [PII] and the last initial is [PII] and the call reference number is my name and today's date.
[CUSTOMER][POSITIVE] OK. Thank you for your help. Have a good day ahead.
[AGENT][POSITIVE] You too, King you have a blessed day and thanks for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye.