AccountId: 011433970860
ContactId: f2d780c8-5986-411f-8a77-e53159cfa78a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235919 ms
Total Talk Time (AGENT): 102948 ms
Total Talk Time (CUSTOMER): 63052 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/f2d780c8-5986-411f-8a77-e53159cfa78a_20250507T15:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, I'm looking to get benefit eligibility on a patient.
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] 02608267
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And verifying the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, it'll be for the child listed, uh, [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. I'm showing an effective date of [PII]. Uh, she is active on the policy. And what benefits are needing for this patient?
[CUSTOMER][NEUTRAL] DME
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, uh, DME is covered under the policy as outpatient, uh, not a guarantee of payment, just a verification of coverage. With this policy, we are secondary. We help with primary insurance deductible, co-pay, and or co-insurance.
[AGENT][NEUTRAL] And try to look up benefits. Give me one moment, I'm sorry.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, um, oh, this is combined, never mind. Uh, so they have a benefit max up to $3000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there any way that I can get like a copy of their benefits for DME Fox to us for our records?
[AGENT][NEUTRAL] Uh, no, ma'am. I'm sorry. We don't, um, send out benefit information, um, only through phone. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, have they put anything towards their deductible or co-payments with you guys?
[AGENT][NEUTRAL] Uh, no, ma'am, they have not met any of their benefits for this year.
[CUSTOMER][POSITIVE] OK perfect um.
[AGENT][NEUTRAL] OK, and is there anything else?
[CUSTOMER][NEUTRAL] Do you have a percentage?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yes, you have a percentage of how much you guys cover as a secondary?
[AGENT][NEUTRAL] Up to that benefit max. So after primary insurance is processed the claim, if there's anything they apply towards deductible, co-pay or co-insurance, that's what we pick up and pay up to that $3000 benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK perfect um last thing I just need your name and a reference number for the call.
[AGENT][NEUTRAL] Uh, it's [PII] last initial [PII], and if you like, you can use my name in today's date of reference.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. Have a great day. Sorry.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.