AccountId: 011433970860
ContactId: f53e53b5-0c7d-40b4-b23c-c772e66c8aeb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437890 ms
Total Talk Time (AGENT): 169031 ms
Total Talk Time (CUSTOMER): 147036 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/f53e53b5-0c7d-40b4-b23c-c772e66c8aeb_20250127T14:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. My name is [PII]. I'm calling you from the provider's office and I have a member. I want to know the eligibility and benefits of the plan.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Can you spell your name for documentation?
[CUSTOMER][NEUTRAL] Sure, that will be for sorry [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK. And the initial of my last name is [PII]. That's [PII].
[AGENT][NEUTRAL] You said your name is [PII] The phone was breaking up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's that's [PII].
[AGENT][POSITIVE] So, thank you. I appreciate that. And what is a good callback number?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the callback number will be [PII].
[AGENT][NEUTRAL] Thank you, So what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, uh, the policy number is, one second, yeah.
[CUSTOMER][NEUTRAL] Uh, that would be 2521747.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Yeah, that's [PII] and uh uh the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you, So, and it would be my pleasure to assist you with eligibility for Carry. I am showing that her policy is active with the effective date of [PII].
[AGENT][NEUTRAL] And this is a secondary policy to the policyholder's primary insurance. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, actually I'm looking for the benefits also. So may I know the coverage, uh, deductible amount?
[AGENT][NEUTRAL] I'm so sorry, the line is breaking up. You're wanting um benefits for what type of service?
[CUSTOMER][NEUTRAL] Uh, that will be DME that's Driver medical equipment.
[AGENT][POSITIVE] OK. Thank you and I can help you with that benefit as well.
[AGENT][NEUTRAL] Now, the benefit for DME is under her outpatient coverage.
[AGENT][NEUTRAL] Of $200 per calendar day.
[AGENT][NEUTRAL] That is what we can pay toward her deductible, co-pay, or co-insurance of her major medical coverage.
[CUSTOMER][NEUTRAL] OK, uh, I have a CPT code for this that is E0601. It's a ship, uh, uh, so kindly could you check with that, please?
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] And again, you stated that CPT is E0601.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that could be considered under the durable medical equipment um benefit. Now, it does have to meet the guidelines.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It cannot be disposable.
[CUSTOMER][NEUTRAL] It does
[AGENT][NEUTRAL] And if it's not disposable, it could be considered for benefits.
[CUSTOMER][NEUTRAL] OK, so what is the coverage percentage?
[AGENT][NEUTRAL] So we pay up to $200 per calendar day.
[CUSTOMER][NEUTRAL] OK. And what is the calendar year?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, the deductible amount is $200 per day.
[AGENT][NEUTRAL] That is the amount that we pay toward the deductible co-pay or co-insurance of the primary insurance.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] There's no deductible on this policy, but that is the amount that we can pay toward her deductible.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and what is there any out of pocket amount?
[AGENT][NEUTRAL] Not on this policy. You would need to check with the primary insurance.
[CUSTOMER][NEUTRAL] OK. And uh once the primary insurance is covered, then this policy will uh provide a 100% coverage for this?
[AGENT][NEUTRAL] Up to that $200 amount, if it is an amount that is applied to the deductible, co-pay, or co-insurance from her primary insurance.
[CUSTOMER][NEUTRAL] OK and uh.
[CUSTOMER][NEUTRAL] Is there any authorization is required for this?
[AGENT][NEUTRAL] Not on the secondary policy authorization is not required.
[CUSTOMER][NEUTRAL] Oh, OK. Thank you, [PII] for this. And is there any group number for this plan?
[AGENT][NEUTRAL] The group number is my name and today's date, and I spell my name, [PII].
[CUSTOMER][NEUTRAL] OK, uh, it is a uh.
[CUSTOMER][NEUTRAL] I believe it's the call reference number I'm asking for the group number of the plan.
[AGENT][POSITIVE] I do apologize. Yes, ma'am, there is a group number and I apologize for that. Let's see, group number is.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] 26616.
[CUSTOMER][NEUTRAL] And what is the plan that?
[AGENT][NEUTRAL] It is a secondary gap policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you very much, [PII], for your help. That's all I needed.
[AGENT][POSITIVE] Well, it's been such a pleasure to assist you with those benefits on them, and you're sure there's nothing else I can assist you with today?
[CUSTOMER][POSITIVE] Oh, that's all. Thank you very much for your help.
[AGENT][POSITIVE] And thank you for calling APL. I hope you enjoy your day.
[CUSTOMER][POSITIVE] Same to you, [PII]. Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.