AccountId: 011433970860
ContactId: f539dc89-3868-4495-aea2-38e270d60d25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 509320 ms
Total Talk Time (AGENT): 139125 ms
Total Talk Time (CUSTOMER): 127562 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/f539dc89-3868-4495-aea2-38e270d60d25_20250129T13:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yeah, hi, my name is [PII] calling from servicing facility. I would like to verify the member eligibility and benefits. Could you please help me with that?
[AGENT][NEUTRAL] Sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can I call back number [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] No, that's our payer ID. Um, if you have the card, the policy number is the outpatient certificate number.
[AGENT][NEUTRAL] On the card.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, I do have a group number. Shall I provide that?
[AGENT][NEUTRAL] Um, I can try. What number?
[CUSTOMER][NEUTRAL] 25921.
[AGENT][NEUTRAL] OK. No, sir, that's not it either. Um, do you have the member's social security number?
[CUSTOMER][NEUTRAL] I know, uh,
[AGENT][NEUTRAL] OK, I could try to look him up by name and date of birth. What's the last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Please spell that?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the first name, please?
[CUSTOMER][NEUTRAL] [PII] I'm sorry, [PII]
[AGENT][NEUTRAL] OK. And what's her date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I found her in our system. Would you like her policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. Her policy number is 024.
[AGENT][NEUTRAL] 91476.
[CUSTOMER][NEUTRAL] OK, could you please repeat your name, ma'am?
[AGENT][NEUTRAL] My name is [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you. Yeah, I'd like to verify the member eligibility and benefits.
[AGENT][NEUTRAL] Yes, sir, and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, may I know the plan type?
[AGENT][NEUTRAL] Um, this is Melink, um, Secondary Gap Insurance.
[CUSTOMER][NEUTRAL] It's a midlink.
[AGENT][NEUTRAL] Mhm. It's secondary gap.
[CUSTOMER][NEUTRAL] Gap plan, right?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, so you're acting as a secondary.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, so do you follow primary guidelines or you have your own guidelines?
[AGENT][NEUTRAL] We follow the primary guidelines.
[CUSTOMER][NEUTRAL] So there is no network, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. May I know the coincidence?
[AGENT][NEUTRAL] Um, we cover up to $250 per day for outpatient services and for inpatient services, we cover up to $500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Is there any patient responsibility?
[AGENT][NEUTRAL] Um, yes, that's per claim. We would have to see the claim.
[AGENT][NEUTRAL] In order to know what's the patient responsibility.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so primary cover 80%.
[CUSTOMER][NEUTRAL] And the remaining 20% will be covered by the secondary fully.
[AGENT][NEUTRAL] Um, it will be covered up to 5 $250 per day for outpatient services and covered up to $500 per calendar year for inpatient services.
[CUSTOMER][NEUTRAL] Um, OK, got it.
[CUSTOMER][NEUTRAL] May I know the individual deductible amount?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] May I know the individual deductible amount?
[AGENT][NEUTRAL] There's no deductible on this policy.
[CUSTOMER][NEUTRAL] Is there any out of pocket?
[AGENT][NEUTRAL] No, I'm not showing any.
[CUSTOMER][NEUTRAL] OK and uh.
[CUSTOMER][NEUTRAL] Uh, could you please verify whether the prior of is required or not for DME codes?
[AGENT][NEUTRAL] There's no prior authorization required because we go by the primary carrier's guidelines.
[CUSTOMER][NEUTRAL] OK. May I know the timely filing limit to submit the claim?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] And the claim mailing address, it is a Medicaid crossover, right?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the call reference number, uh, AV?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Yeah, I need one more clarification. So you told there is no coinsurance, which means 0% right?
[CUSTOMER][NEUTRAL] The insurance will cover 250 fully.
[AGENT][NEUTRAL] Yes, per day, per day for outpatient services. Yes, sir.
[CUSTOMER][NEUTRAL] For outpatient.
[CUSTOMER][NEUTRAL] OK. So then there is no coincidence, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hello, [PII], is there any
[CUSTOMER][NEUTRAL] $250 per day, 2 $250 per day, right? For outpatient.
[AGENT][NEUTRAL] Yes, for yes, for outpatient services.
[CUSTOMER][POSITIVE] OK EV and yeah, that's it for today's call and thank you for your wonderful assistance. Have a great day. Take care, bye.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?