AccountId: 011433970860
ContactId: cbdaaa35-67b4-4b8c-94cd-54a4c73c58c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366730 ms
Total Talk Time (AGENT): 135610 ms
Total Talk Time (CUSTOMER): 170451 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/cbdaaa35-67b4-4b8c-94cd-54a4c73c58c1_20250620T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, thank you for calling APL. This is [PII]. How can we help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII]. My name is [PII] calling from Genentech Access Solutions. Is at the request of provider behalf of patient. Call may be monitored and recorded for quality and training. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII] how are you?
[CUSTOMER][POSITIVE] Doing good, thank you. Um, I'm calling today to uh obtain benefits and eligibility on this patient's policy.
[AGENT][POSITIVE] Sure, yeah, I can check eligibility and benefits for you. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Absolutely I have to say it this way. Genentech Access Solutions best call back is [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] I do, yeah, policy number for this patient is gonna be 1420113.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you so much for verifying that. Uh, so this policy is active. That effective date was [PII].
[AGENT][NEUTRAL] And this is a limited indemnity medical plan, so pays a set dollar amount per covered procedure or office visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] If you'll give me one moment, I will get that policy pulled up and we can go over those benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, what kinds of benefits were we needing to check for the member?
[CUSTOMER][NEUTRAL] Uh, yeah, so for starters, you said it was a limited indemnity set plan. So I just want to confirm it, is it running calendar year?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is it self-funded or fully insured?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] No problem. Is this self-funded or fully insured?
[AGENT][POSITIVE] Fully insured.
[CUSTOMER][NEUTRAL] OK. And then,
[CUSTOMER][NEUTRAL] Oh, hold on one second. My system's not complying. I have a group number here 70052 for the Oxford Global Resources. Is that correct?
[AGENT][NEUTRAL] Let me verify that.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] 70052, yes.
[CUSTOMER][NEUTRAL] Mm OK. Um, I am calling to see, so this is gonna be for a non-chemo infusion of a biologic drug. It will be done in an office specialist setting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check the office coverage.
[AGENT][NEUTRAL] And you said this was for an infusion is just regarding a sickness?
[CUSTOMER][NEUTRAL] For it, uh, the diagnosis code associated is for multiple sclerosis.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, so they do have um office visit sickness benefits and that would pay up to $75 per visit.
[AGENT][NEUTRAL] And that is limited to 5 visits per calendar year.
[CUSTOMER][NEUTRAL] But it
[CUSTOMER][NEUTRAL] There's office visit sickness benefits. When you say sickness, does that mean an illness or a chronic illness?
[AGENT][NEUTRAL] Uh, it would all fall under that category. Sure, yeah, that, uh, it would all fall under that category.
[CUSTOMER][NEUTRAL] There's multiple sclerosis one of the.
[CUSTOMER][NEUTRAL] OK, so MS does fall under that category, falls under category.
[CUSTOMER][NEUTRAL] And you said there was a $75 payout essentially?
[AGENT][NEUTRAL] Um, that's the total benefit amount. This policy doesn't have any sort of co-pays or deductibles or anything like that. The maximum benefit we would pay is $75 per visit.
[CUSTOMER][NEUTRAL] OK. So you guys would pay.
[CUSTOMER][NEUTRAL] Contribute essentially $75 to the patient's co-pay for the office visit, right?
[AGENT][NEUTRAL] Um, not necessarily to the co-pay, just in general, that's the benefit amount.
[CUSTOMER][NEUTRAL] OK, so for the office services in general as a whole, and then uh, would there be like a max limit, yearly limit, lifetime limit?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] To this benefit, other than the 5 is it?
[AGENT][NEUTRAL] So it is the.
[AGENT][NEUTRAL] No, um, so yeah, it's limited to the $75 max per visit, and that is a maximum of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] OK. Um, just wondering if there was some sort of limit on the policy. Um, and if primary would I, it sounds like you guys are not necessarily trying to step up as a primary. You guys are purely supplemental, correct?
[AGENT][POSITIVE] Purely supplemental, yes, that is correct.
[CUSTOMER][NEUTRAL] OK, um, and then would there be any special review required that you guys have guidelines to, or is it just kind of just automatic crossover and you guys pay?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Right, automatic.
[CUSTOMER][NEUTRAL] OK. Uh, in that case, I believe that should be the last question actually, Ms. [PII]. Thank you so much for your time. Can I go ahead and, yes, ma'am. Can I just, perfect. And then, um, just one of my criteria. I just need to grab a reference number if that's OK.
[AGENT][POSITIVE] All right. You are very welcome.
[AGENT][NEUTRAL] No worries, that would just be my first name, last initial, and today's date. And so my name is spelled [PII] and there wasn't anything else I could help you with?
[CUSTOMER][POSITIVE] No, thank you. You've been wonderful. I hope you have a wonderful day.
[AGENT][POSITIVE] All right. Thank you, you too bye bye.
[CUSTOMER][NEUTRAL] Mhm. Bye.