AccountId: 011433970860
ContactId: d732b4ab-0014-4c46-a0fd-3102cb826728
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337040 ms
Total Talk Time (AGENT): 128908 ms
Total Talk Time (CUSTOMER): 86507 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/d732b4ab-0014-4c46-a0fd-3102cb826728_20250401T15:38_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, uh, good morning. Uh, I'm calling with AdventHealth Respirator and Equipment. We have a patient that have listed, uh, you guys as a secondary insurance, and we wanna know if we are in network with you guys and the benefits for the patient and all that.
[AGENT][NEUTRAL] OK, yeah, I'd love to help you look up some network information and then the benefits. Um, would you mind if I get your name? I'm not sure if I caught it.
[CUSTOMER][NEUTRAL] Yeah, no, I didn't say it. My name is [PII].
[AGENT][POSITIVE] [PII], thank you sir and um real quick do you mind if I snag a good call back number [PII] in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you and what's the member's policy number so we can look into that policy for you?
[CUSTOMER][NEUTRAL] It is 1,581,960, M as in Mary, L as in Larry, and number 8.
[AGENT][NEUTRAL] 1,581,960 ML 8 is that correct?
[CUSTOMER][NEUTRAL] 1,581,960 ML 8 yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me a moment. It's going a little slow, but it should be loading.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] All right. Would you be able to verify for me, please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] I do see that she is current and active with us with an effective date of [PII], no, I'm so sorry, yeah, [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sorry, [PII] what year?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], [PII], OK.
[AGENT][NEUTRAL] Mhm, um, this policy we are her supplemental secondary insurance, so we don't have a network we do just follow the major medical insurance on this one,
[AGENT][NEUTRAL] And then
[AGENT][POSITIVE] For benefits I can look in, oh, I'm so sorry.
[CUSTOMER][NEUTRAL] You guys like
[CUSTOMER][NEUTRAL] You guys are like a like a you guys like a gap insurance.
[AGENT][NEUTRAL] Yes, this policy is a gap insurance, um, and then I can help you with benefits as well. I do just need to let you know that any benefits given over the phone is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] All right, OK.
[CUSTOMER][NEUTRAL] OK, um, so.
[CUSTOMER][NEUTRAL] Uh, one of the things I want to know if a patient has, uh, durable medical equipment coverage as part of the benefits.
[AGENT][NEUTRAL] Oh, OK, yeah, I can definitely look into that. And are we looking at um inpatient or outpatient benefits today in general, do you know?
[CUSTOMER][NEUTRAL] Out outpatient.
[AGENT][NEUTRAL] Outpatient, OK. And let me pull up their policy document and find out about the durable medical equipment for you.
[AGENT][NEUTRAL] All right, I'm not showing that uh durable medical equipment is listed as uh covered under her policy.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Not a problem. Just wanna confirm that very important part of it.
[AGENT][POSITIVE] No worries. Um.
[CUSTOMER][NEUTRAL] So they
[CUSTOMER][NEGATIVE] Women is not covered on this this spot.
[AGENT][NEUTRAL] I do
[AGENT][NEUTRAL] No, I'm not showing it's covered. I mean, I always recommend submitting a claim. I think it's better to have a claim denied than this benefits payable, um, so I definitely recommend just sending a claim in.
[AGENT][NEUTRAL] But I don't see it listed as any of her covered outpatient benefits. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Not a problem, not a problem. Just wanna check that, OK? So I can, uh, notify the patient, OK?
[AGENT][POSITIVE] Absolutely. Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No thank you very much. I really appreciate your help. Uh, yes, can you give me a reference number for this call?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You betcha. It's my name, [PII], first initial, last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, I'll be today's date. OK, thank you.
[AGENT][POSITIVE] Hey, it's my pleasure thanks for calling APL and you have such a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks bye bye.