AccountId: 011433970860
ContactId: 032c01ae-e89b-4dbc-aa0e-e86c7c8f7ac9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254660 ms
Total Talk Time (AGENT): 124309 ms
Total Talk Time (CUSTOMER): 72932 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/032c01ae-e89b-4dbc-aa0e-e86c7c8f7ac9_20250423T12:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling just to verify um if you guys cover the rest of the co-pay for um a patient she has united as a primary and you guys at the secondary.
[CUSTOMER][NEUTRAL] Zip code?
[AGENT][NEUTRAL] OK, so you're needing benefit information on a member, is that correct?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that please?
[AGENT][NEUTRAL] Are you needing benefit information on the member?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from Walking Urgent Care. Would you like a receipt?
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02566935. You'll be in shortly.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today will be a verification of benefits, [PII], and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and her date of birth, give me one second and I'll pull that up for you. Her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's loading some information for me, so bear with me just a moment.
[CUSTOMER][POSITIVE] Mm, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that she is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And does she, excuse me, she does have an outpatient benefit maximum of $6800.
[CUSTOMER][NEUTRAL] OK, so, so.
[AGENT][NEUTRAL] Her cover person per calendar year for covered outpatient services, so you all would need to submit the claim to her primary insurance first. And then with APL because we will have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Showing the amounts supplied to either the copay deductible or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So let's say she has a $100 copay with her primary insurance, so you guys cover the rest of that, would I have to collect something?
[AGENT][NEUTRAL] Again.
[AGENT][NEUTRAL] Again, I cannot guarantee payment, [PII]. I can only provide you with what the benefit information is on the policy. We would just have to receive the claim for review. Yes, ma'am. And also, one last thing, [PII], if you will submit the claim to us for review, once it's been completed, we do have a portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] In which you should be able to check our claim status site for that. It's located at [PII].
[CUSTOMER][POSITIVE] Security. OK, perfect, thank you.
[AGENT][POSITIVE] Yes, ma'am. If you're, you're welcome. So again, is there anything else that I can help you with this morning?
[CUSTOMER][POSITIVE] Um, that's everything. Thank you so very much.
[AGENT][POSITIVE] Well, you're welcome, [PII] and thank you again for calling APO. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.