AccountId: 011433970860
ContactId: e2aeacb3-fafe-45b6-aaea-673ffbdd6ee4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414160 ms
Total Talk Time (AGENT): 182261 ms
Total Talk Time (CUSTOMER): 160471 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/e2aeacb3-fafe-45b6-aaea-673ffbdd6ee4_20250509T15:31_UTC.wav
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[AGENT][NEUTRAL] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider office.
[AGENT][NEUTRAL] Hi, Mr. [PII] and how may I assist you today?
[CUSTOMER][NEUTRAL] I just want to check the benefits and the eligibility of the patient plan.
[AGENT][NEUTRAL] Mhm. Sure, I can assist you with the eligibility and benefits. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the call back number is just [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what's the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] cardiovascular consultant.
[AGENT][POSITIVE] Is gonna OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Just a moment. The policy number is 02489440 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, the name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you say you need eligibility and benefits and the benefits is gonna be for a specialist?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, for the specialist office visit and especially for the outpatient.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. This is uh one of our secondary supplemental plan to the major medical. We have an effective date of [PII]. It is active at the moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And with this one.
[CUSTOMER][NEUTRAL] If the plan is active, right?
[AGENT][NEUTRAL] Yes, it is active at the moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And with this one, it looks like we covered the office treatments. We do not cover the office visit, but we do cover the office treatments. This is subject to the outpatient maximum, which is $500 per day.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, uh, does this plan cover both deductible and co-insurance of medical leftover?
[AGENT][NEUTRAL] This particular policy is to help with the deductibles, co-payment, and co-insurance from the major medical. Now again, this one doesn't cover the office visit, it will only cover procedures done in office, OK?
[CUSTOMER][NEUTRAL] Part B.
[CUSTOMER][NEUTRAL] OK. So it means it will cover both, right? Of Medicare Part A, uh sorry, Part B.
[AGENT][NEUTRAL] It's not gonna be Medicare Part B. It's gonna be the major medical, major medical. Let me see what's the major medical on this 11 moment. Mhm, yes, the major medical.
[CUSTOMER][NEUTRAL] Me
[CUSTOMER][NEUTRAL] Major medical
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's gonna be you.
[CUSTOMER][NEUTRAL] And is there any deductible and out of pocket for this?
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] OK, there is no.
[AGENT][NEUTRAL] Mhm. No, and we follow, mhm.
[CUSTOMER][NEUTRAL] So just a moment, I will connect my I will connect to my supervisor on my call, so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She will confirm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Good morning. This is [PII]. It's [PII]. How are you doing today?
[AGENT][POSITIVE] I'm good, thank you. How about you, Ms. [PII]?
[CUSTOMER][POSITIVE] I'm also doing well, yes, actually, my concern is regarding eligibility and benefits for the patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah. So I just want to confirm that if the, it will, patient's policy is active and it will cover the Medicare Part B, deductible and co-insurance quote, or is there any patient responsibility for the services?
[AGENT][NEUTRAL] Ms. [PII], and like I was telling [PII], um, this particular policy is secondary to the major medical. United Healthcare is the major medical, so we're gonna be the secondary to United Healthcare.
[CUSTOMER][NEUTRAL] OK. So according to your record, the Medicare is a primary insurance and you are the secondary, correct?
[AGENT][NEUTRAL] Can you repeat that?
[CUSTOMER][NEUTRAL] Yes. According to the record for the medical services, the United Healthcare is the primary and you are the secondary. Is that correct?
[AGENT][NEUTRAL] That's correct. United Healthcare is the primary and we are the secondary.
[CUSTOMER][POSITIVE] OK, thank you so much. And is it possible if you can provide me with the United Healthcare member ID?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We don't have that information. You will have to contact the member to get that information.
[CUSTOMER][NEUTRAL] OK, no problem. And according to the secondary, what will you guys will be covered? I mean, it will cover the USC Medicare uh services co-pay, deductible co-insurance. Uh, is there any patient responsibility in this plan?
[AGENT][NEUTRAL] OK, um, Ms. [PII], this is a secondary supplemental plan to the major medical. So it's set up to help with the high deductibles, co-payment, and co-insurance. Now, we only cover for procedures done in the office. We do not cover the office visit.
[AGENT][NEUTRAL] And this is just a guarantee of payment, not verification of coverage, not guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And you, OK. And could you please also confirm if it will be covered the patient's specialist office visit services?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, we do not cover the office visit, we only cover office procedures.
[CUSTOMER][POSITIVE] OK, thank you so much for that information and could you please spell out your name for me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. My name is [PII] [PII].
[CUSTOMER][NEUTRAL] And that's OK and let me verify your reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Thank you so much. Sorry for assisting me. Have a great day. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. You too as well, Ms. [PII], and thank you for calling APL. Have a good weekend. Bye-bye.