AccountId: 011433970860
ContactId: efbe3096-c3b3-4f0c-9ff7-9b3cc0138457
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299489 ms
Total Talk Time (AGENT): 168688 ms
Total Talk Time (CUSTOMER): 94261 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/efbe3096-c3b3-4f0c-9ff7-9b3cc0138457_20250121T21:04_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, [PII]. My name is [PII], and I need to verify benefits for a patient, please.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some benefit information today, and Ms. [PII], do you mind if I snag a quick call back number from you?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Thank you. And what's that member's policy number today?
[CUSTOMER][NEUTRAL] 02462910
[AGENT][POSITIVE] Wonderful, thank you very much.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and would you be able to verify for me pretty please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Alright, I'm pulling up those benefits are we looking for inpatient or outpatient today?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Perfect. I do wanna let you know that any benefit information I give you over the phone is always just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the outpatient benefit I'm seeing here is a combined calendar year, it's combined between inpatient and outpatient of $4500.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And that's the deductible? I'm sorry, say that again please.
[AGENT][NEUTRAL] No, you're OK. So that's just their benefit amount. So we're like a secondary supplemental insurance, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so it's money that we would apply towards their co-pay, their co-insurance or their deductible for major medical, um, and then
[AGENT][NEUTRAL] I'm so sorry. I feel like I just like might have said the same thing twice, um.
[AGENT][NEUTRAL] So the benefit is the $4500. Um, they do have an outpatient deductible with us for accidents and sickness. Um, so if they're being seen for accident or sickness, they have a deductible of $1500 in a calendar year to meet.
[CUSTOMER][NEUTRAL] I have those days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now, this is gonna be for durable medical equipment and it's gonna be secondary to a commercial policy.
[AGENT][POSITIVE] OK, perfect. So they do have a DME rider, so it does look like they have um coverage for DME.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, so then would this policy cover her primary policy's deductible and co-insurance amount or just the co-insurance once she meets her deductible?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So I, I believe it's just.
[AGENT][POSITIVE] And I'm so sorry. So.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] I think I, I don't, I don't know exactly, uh, because I don't process the claims, so it's supposed to help apply to their co-pay coinsurance or deductible. Um, I if they have a deductible amount.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And a co-insurance. I'm not sure how it would work. I think as long as benefits were paid where it was applied to their deductible, um, but I like I can't know that like for a fact because I don't process the claims. Um, but once they meet their $1500 with us, the, the rest of their benefits would kick in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I got it. I'm sorry, her primary policy is confusing as well, so I'm just trying to make sure I've got everything straight.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] I feel like all insurance is a little confusing, ma'am.
[CUSTOMER][NEUTRAL] And you said
[AGENT][POSITIVE] So I'm right there with you.
[CUSTOMER][NEUTRAL] Yes, most of it is. It's crazy. Um, but you said that this was applicable to her co-insurance deductible and one other?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Copay.
[CUSTOMER][NEUTRAL] Co-pay, yes, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] And that amount, like once she meets $1500 with you guys, then she's covered at 100%.
[AGENT][NEUTRAL] Um, yes, basically, uh, so her benefit, as long as it's within the purview of her policy, uh, she'll be able to get her benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, she'll be appreciative of that hopefully, but alright, well that's everything, Mr. [PII], can I please have a um call reference number?
[AGENT][NEUTRAL] Yes, absolutely. So the reference number is my name, [PII], my last initial and today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you, ma'am.
[AGENT][POSITIVE] Yeah, my pleasure thank you so much for calling APL and you have a fabulous day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thanks bye bye.