AccountId: 011433970860
ContactId: f30e29df-51b9-4613-b037-5c639ea3e9a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398140 ms
Total Talk Time (AGENT): 140480 ms
Total Talk Time (CUSTOMER): 171749 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/f30e29df-51b9-4613-b037-5c639ea3e9a9_20250227T19:37_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, I'm sorry, your name was [PII]? I didn't catch that.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK, uh, my name is [PII] calling from the provider's office to check the member's eligibility and benefits. Can I have your last name's initial?
[AGENT][NEUTRAL] It is [PII], so the reference will be first name, last initial, and today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Great thanks.
[AGENT][NEUTRAL] You're welcome. May I please have a callback number?
[CUSTOMER][NEUTRAL] Sure, that would be [PII] and that's a direct line.
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Certainly. Uh, it's D for Delta 43731637.
[AGENT][NEUTRAL] OK, that one's not our policy number. I'll start with the 0.
[AGENT][NEUTRAL] Do you have the image of the card with you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No, um, they only gave us like their member ID, um, are you able to pull up using a name and date of birth?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] May I please have the first and last name please?
[CUSTOMER][POSITIVE] Perfect. Her name is [PII]
[CUSTOMER][NEUTRAL] And her last name is [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And you're welcome. Do you also need her date of birth?
[AGENT][NEUTRAL] Once I pull the member's name up, then I will verify with the date of birth as well.
[CUSTOMER][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] And may I have the date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the correct policy number for us would be 02.
[AGENT][NEUTRAL] 53
[AGENT][NEUTRAL] 7810 that the policy number would be for benefit in a car.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][POSITIVE] Great thank you so much.
[AGENT][NEUTRAL] You're welcome and you were calling in for eligibility and benefits. Is there a specific benefit that you're calling in for?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, so, um, I need the member's benefits for continuous glucose monitors or CGM. I have CPT codes to check as well if they are covered and billable or if it's covered through DME diabetic supplies or pharmacy. Would you like to get a codes now or do you wanna pull up first the member's policy?
[AGENT][NEUTRAL] I'm pulling the member's information up and we don't verify via the code. It's either just for an office setting outpatient, and as you stated, DME.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, this is for outpatient supplies will be shipped to the patient's home.
[AGENT][NEUTRAL] OK, so that would be considered durable medical equipment.
[CUSTOMER][POSITIVE] DME OK, great.
[AGENT][POSITIVE] And I'm pulling that up for you.
[CUSTOMER][NEUTRAL] And if you have the policy pulled up, OK, uh, if you, if you have the policy pulled up, uh, I have some eligibility questions before we proceed with the benefits.
[AGENT][NEUTRAL] OK. What would you like to know for the member's eligibility?
[CUSTOMER][NEUTRAL] Mm, yeah, just the basic ones like the start date, you know, termination date if there's any.
[AGENT][NEUTRAL] OK, I'm pulling that up for you now. It does show that the policy is currently active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Thank you, no termination date.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] No, it's currently active.
[CUSTOMER][NEUTRAL] OK, and you are currently showing as their primary insurance, right?
[AGENT][NEUTRAL] They could have other insurance. This is an indemnity policy.
[CUSTOMER][NEUTRAL] OK, indemnity.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So it's a commercial, uh, you follow your own guidelines.
[AGENT][NEUTRAL] It's based off of the member's contract.
[CUSTOMER][NEUTRAL] OK, but does it run in a calendar year?
[AGENT][NEUTRAL] This is a per calendar year benefit, but it is based off of the member's weekly premiums.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And one moment here.
[CUSTOMER][NEUTRAL] Does the member have out of network benefits?
[AGENT][NEUTRAL] With this being an indemnity policy, this is not considered like a major medical, so it's not an in or out of network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you have any group number for billing purposes?
[AGENT][NEUTRAL] The group number is?
[AGENT][NEUTRAL] 70056.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, now if we submit the claim to you guys, uh, do you send the payment to us or you send it to the member?
[AGENT][NEUTRAL] We will submit it to whoever we receive the claim in from.
[CUSTOMER][POSITIVE] Perfect. OK.
[CUSTOMER][NEUTRAL] OK, now, um.
[CUSTOMER][NEUTRAL] Can I have oh what's the name of their plan or the description of their policy?
[AGENT][NEUTRAL] The name of the plan is an indemnity or limited benefit plan.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] OK, um, can you pull up the member's benefit like any coinsurance, deductible, or out of pocket?
[AGENT][NEUTRAL] And in regards to this policy, verification of coverage does not guarantee the payment of the claim. You were calling in regards to durable medical equipment. The member does not have that benefit rider. Is there anything else that I can assist you with today for you?
[CUSTOMER][NEGATIVE] Oh, I see. Yeah, so this member doesn't have benefits for durable medical equipment.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much. Alright, that would be all. Uh, thank you so much, uh, [PII]. You have a great day bye bye.
[AGENT][POSITIVE] You're welcome. Thank you [PII]or calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] Mhm.