AccountId: 011433970860
ContactId: 0293a611-5186-44da-8961-05c45309bc99
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454869 ms
Total Talk Time (AGENT): 191275 ms
Total Talk Time (CUSTOMER): 162902 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/0293a611-5186-44da-8961-05c45309bc99_20250425T17:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], last initial [PII], and I needed to see if I could get some help, uh, figuring out some benefits for your patients or how this plan covers.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the benefits and eligibility and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] 144653 M as in Mary L as in Lima 8
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] I think I'm missing a number. 144653.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Oh, those are the only numbers. Hold on. Something's missing.
[CUSTOMER][NEUTRAL] Uh, let me see, let me look at the card real quick.
[CUSTOMER][NEUTRAL] Yeah, it says uh outpatient benefit cert number 14,465,300 ML 8. I'm sorry, I was missing something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh no, it's OK hold on one moment.
[AGENT][NEUTRAL] OK, here we go. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yeah, it's [PII], [PII].
[CUSTOMER][NEUTRAL] She's part of the family. The, the policyholder is [PII], and I do not have his date of birth since he's not the patient that I'm seeing.
[AGENT][NEUTRAL] Oh, it's OK, and you said [PII]?
[CUSTOMER][NEUTRAL] Uh-huh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And thank you for verifying and all the information provided is a verification of benefits, not a guarantee of payment. So this particular policy number is no longer active. Um, it was effective from [PII], but she does have an active policy. Hold on one second.
[AGENT][NEUTRAL] And let me get that policy number for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the active policy is 196.
[AGENT][NEUTRAL] 7205.
[AGENT][NEUTRAL] And this policy has been active since [PII].
[AGENT][NEUTRAL] So this is their secondary gap insurance and we apply to the co-pay, deductible and co-insurance of coverage charges after their Florida Blue.
[AGENT][NEUTRAL] Um, are you all considered outpatient? I'm sorry.
[CUSTOMER][NEUTRAL] OK, so you all pick up.
[CUSTOMER][NEUTRAL] Uh, yeah, yeah, yeah, yeah, we are, um, considered, um, just specialty office outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you were going to um ask a question?
[CUSTOMER][NEUTRAL] Yeah, I was like, is it, is it kind of like a Medicare supplemental plan where you all just pick up, you pick up whatever deductible the patient has with their primary and their co-pay or co-insurance?
[AGENT][NEUTRAL] Mhm. So we're not a, well, no, we're not affiliated with Medicare. There, so for example, this policy.
[CUSTOMER][NEUTRAL] No, no, no, I know, I know.
[AGENT][NEUTRAL] The um outpatient calendar year max is $6000 per calendar year. So they have that to use for their different outpatient expenses, the emergency room, urgent care, outpatient surgeries, um, diagnostic testing, uh, physical therapy.
[CUSTOMER][NEUTRAL] OK, and do you know, do you know how much of that they've used this year?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So [PII], hold on one moment let me total it.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So she's used $5,0081.28. She has $918.72 left for the year.
[CUSTOMER][NEUTRAL] You said um sorry my computer wasn't typing. What was the amount used 5000, was it 81?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. 81, yes, and 28 cents.
[CUSTOMER][NEUTRAL] 12 OK so that's what she's used to date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. Um, let's see here. And so like no.
[AGENT][NEUTRAL] And she has 900 and did you get the
[AGENT][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] Oh, that's OK. I don't need that part. Um, and does she need to have like an authorization or anything for physical therapy?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, um, no prior author pre-cert is required.
[CUSTOMER][NEUTRAL] OK. And there's no types of deductibles or co-insurances on this policy, right?
[AGENT][NEUTRAL] Let me double check and see if this policy has any deductibles. Hold on one moment.
[AGENT][NEUTRAL] No, this policy doesn't have any deductibles.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's that maximum on it, OK, and this runs in the calendar year as well?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And is it considered, uh, do you know what type of like what plan type this is?
[AGENT][NEUTRAL] So, plan type is
[CUSTOMER][NEUTRAL] It's not like a PPO or like.
[AGENT][NEUTRAL] No, it's a, in our system, the plan is meddling, but no, it's not on a, it's not a major network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine. And then, um, do you, do we need to be in network with you all in order for it to be used or is it kind of like an open access they can go anywhere?
[AGENT][NEUTRAL] Well, we're 2nd to [PII], so we don't have a network.
[CUSTOMER][NEUTRAL] So as long as, OK, so as long as we're in network with Florida Blue then you guys would pick up.
[AGENT][NEUTRAL] Right, but this policy does have its own benefits, so.
[AGENT][NEUTRAL] Yes, we will, but you know, particularly to the policy.
[AGENT][NEUTRAL] Which is the calendar year max you went over. Mhm.
[CUSTOMER][POSITIVE] OK, which are the, what we, OK, that we do over. OK, perfect. I think I've got everything.
[CUSTOMER][NEUTRAL] That I needed.
[CUSTOMER][NEUTRAL] For some reason my computer is giving me a hard time, of course. There we go.
[AGENT][NEUTRAL] Oh, take your time, it's fine.
[CUSTOMER][NEUTRAL] I'm like, come on computer.
[AGENT][POSITIVE] It's like it's Friday. I'm ready to go too.
[CUSTOMER][NEUTRAL] Alright, I'm like, I won't be able to then. All right, then all I need is a call reference, please.
[AGENT][NEUTRAL] Um, so there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you so much for your help today.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that was all. Thank you.
[AGENT][POSITIVE] Alright, well thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.