AccountId: 011433970860
ContactId: cfd6a167-c58a-4eed-8f8a-0ec8ea428727
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443690 ms
Total Talk Time (AGENT): 177156 ms
Total Talk Time (CUSTOMER): 169260 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/cfd6a167-c58a-4eed-8f8a-0ec8ea428727_20250304T23:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from National Seing and Mobility, and I was just checking on a new client that needs some power wheelchair repairs on their secondary insurance they just gave me, um, and it is this American public life insurance company, um, and we're not really familiar with it, so I'm just checking their eligibility and benefits and then I had a couple of other questions too, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, Ms. [PII], I can help you. Um, can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. That's a direct number, no extension.
[AGENT][NEUTRAL] OK, thank you, and you're wanting um eligibility and benefits on what is the patient's name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's for [PII] and it's [PII] Last name is [PII]
[AGENT][NEUTRAL] Thank you. And what's [PII]'s date of birth and policy number?
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[CUSTOMER][NEUTRAL] And the policy number, let me get that for you. Hang on, I just had the insurance card up let me get that. Oh there it is.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um, let's see, oh.
[CUSTOMER][NEGATIVE] That is the wrong insurance card sorry about that, hang on.
[AGENT][POSITIVE] That's OK, go ahead and take your time.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I was looking at primary here we go policy cert number is 0215.
[CUSTOMER][NEUTRAL] 0691.
[AGENT][NEUTRAL] OK, and Ms. [PII], I did not catch the name of the facility that you're calling from when you first, I know you said it, but I didn't catch it all. Can you please repeat it?
[CUSTOMER][NEUTRAL] Oh, that's OK, it's
[CUSTOMER][POSITIVE] Yeah, it's national seating and mobility. I usually see it so fast sorry.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] Alright, let me go ahead and pull in this patient real quick so that we can get her eligibility and benefits.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, I do show that Ms. [PII] does have an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits.
[AGENT][NEUTRAL] It's not a guarantee of payment.
[AGENT][NEUTRAL] What she has is a supplemental insurance policy. It's billed secondary to the primary. This policy helps with her deductible, co-pay and co-insurance, and she has, she has an inpatient calendar year benefit amount of $4000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But then she also has an outpatient calendar year benefit of $2000 and that those benefits do go towards the deductible, the co-pay, or the co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] OK, and where, where is she at with meeting those amounts?
[AGENT][NEUTRAL] Let me see, uh, and this will be outpatient, so let me look and see if she's used any of our benefits this year at all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] No ma'am, she's not used anything for the year of [PII] for outpatient or inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you said it was 4000 is the out of pocket?
[AGENT][NEUTRAL] No, that's her benefit amount. That's her benefit amount. It's 4000 is for inpatient if she's in the hospital for more than 18 hours.
[CUSTOMER][NEUTRAL] Or deductible.
[CUSTOMER][POSITIVE] Oh, benefit amount, got it.
[AGENT][NEUTRAL] And then the 2000 was for the outpatient calendar year benefit amount.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK, perfect. OK, because um she has some power wheelchair repairs and um the um United Healthcare has, um, the deductible has not been met yet. So there's an amount on here that she has to pay of 54635.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we would be able to then go ahead and bill that amount to you guys for that for power wheelchair repairs.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Well, it's, it's the
[CUSTOMER][NEUTRAL] Or DME?
[AGENT][NEUTRAL] It's let me see if she has DME on her policy.
[CUSTOMER][POSITIVE] Oh, yes, yes, please check that. Thank you.
[AGENT][NEUTRAL] Let me pull that up. You're welcome. It's gonna be just a second while the policy pulls in for us.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] It's gonna be just a second. I'm gonna scroll through and see if I can find anything that has DME on it for her.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I haven't forgot about you. I'm still looking.
[CUSTOMER][NEUTRAL] Oh, that's OK
[CUSTOMER][NEUTRAL] I figured.
[AGENT][NEUTRAL] OK, let me pull up her benefits on her policy real quick because I did not see it in her actual policy or certificate, so I'm gonna look someplace else real quick.
[AGENT][NEUTRAL] She does not have DME for on her policy.
[CUSTOMER][NEUTRAL] Oh, OK, no DME on the policy. OK, got it.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, that is good to know. OK. And you said your first name was [PII]?
[AGENT][NEUTRAL] Yes, ma'am, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Why, OK, thank you so much. And is there a call reference number?
[AGENT][NEUTRAL] Yeah, my mom spelled it, the boy name.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Oh, I love it. It's beautiful.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, you can use my name in today's date.
[CUSTOMER][POSITIVE] It's unique.
[CUSTOMER][POSITIVE] OK, and today's date, got it, [PII]rfect. OK, thank you so much. I appreciate your help today, [PII]. Take care. Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] You're very welcome, [PII]. I hope you have a good night and thank you for calling APL.
[CUSTOMER][POSITIVE] You too thank you all right bye bye.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Bye bye, ma'am.