AccountId: 011433970860
ContactId: 02b54d64-2730-48ee-a3f5-19f7f211503c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274779 ms
Total Talk Time (AGENT): 140889 ms
Total Talk Time (CUSTOMER): 73011 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/02b54d64-2730-48ee-a3f5-19f7f211503c_20250220T18:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII]. I'm just calling to verify benefits for a member, please.
[AGENT][NEUTRAL] OK [PII], you're needing to verify benefits only. Do you also need eligibility?
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][NEUTRAL] Or just benefits.
[CUSTOMER][NEUTRAL] Well, I mean, it's just benefits really if the policy is active and.
[AGENT][NEUTRAL] OK, so you, you do need eligibility. Yes, sir, I can help you with those things. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] Um, area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and what is the member's policy number that you're calling about?
[CUSTOMER][NEUTRAL] 1988421
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, office and, uh, it's for physical therapy.
[AGENT][NEUTRAL] OK, so office visits are not covered on the supplemental policy?
[AGENT][NEUTRAL] She does have an office treatment writer that we can review the treatment under and that her outpatient benefit max per calendar year for covered outpatient services is $5000.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, um, when we called last year and I verified last year like late.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In the year, I think it was, I don't know if it was November, December, I was told that um.
[CUSTOMER][NEUTRAL] For physical therapy was covered for office. So you're saying it's not covered for, for office?
[AGENT][NEUTRAL] No, so that's not what I said. If she's charged an office visit, see, that is not covered. We can review the treatment, the treatment itself under her outpatient benefit maximum.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, I'm sorry, I misunderstood you. OK.
[AGENT][POSITIVE] That's OK. No, no worries. And because
[CUSTOMER][NEUTRAL] No, no, well, we're not, of course we're not gonna charge you anything if you know you guys are gonna pick up.
[CUSTOMER][NEUTRAL] What are the charges
[AGENT][NEUTRAL] Again, we can review the treatment.
[AGENT][NEUTRAL] Under her outpatient benefit.
[CUSTOMER][NEUTRAL] Mhm, OK, understood.
[AGENT][NEUTRAL] And then because it is a supplemental plan, Oscar to our primary insurance when you all submit the claim to us for review, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Certainly.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you should be able to check our claim status and have access to our EOB.
[AGENT][POSITIVE] And that portal website for us is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Uh, uh, no, [PII], you've answered all my questions. Can I have a reference number, please?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, perfect. You have a great day.
[AGENT][POSITIVE] OK. Well, I hope you have a great day too, and thank you again for calling [PII].
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][NEUTRAL] All right, bye bye.