AccountId: 011433970860
ContactId: 0595fe54-e946-4ea1-b1c8-125b306401d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347929 ms
Total Talk Time (AGENT): 122325 ms
Total Talk Time (CUSTOMER): 123722 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/0595fe54-e946-4ea1-b1c8-125b306401d1_20250325T15:31_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Hi, I'm taking eligibility status for this patient.
[AGENT][POSITIVE] I'd be happy to assist with the eligibility. May I have your first name, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And [PII], if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 01960606 M for Mary L for Lima 8
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, 1st and 1st name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] OK, sir.
[AGENT][NEUTRAL] I do show the outpatient calendar year maximum is $7350.
[CUSTOMER][NEUTRAL] OK, effective from [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Alright, OK, this is the uh.
[CUSTOMER][NEUTRAL] Uh, primary or current insurance?
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] Yeah, this patient was sending insurance.
[CUSTOMER][NEUTRAL] Premier.
[AGENT][NEUTRAL] No, we're the gap insurance, we're not the primary.
[CUSTOMER][NEUTRAL] Right. Your primary is Medicare, is that correct?
[AGENT][NEUTRAL] Um, I don't know who the primary is. You would have to ask that question to the member.
[CUSTOMER][NEUTRAL] OK. OK. OK. Can you provide a plan, yeah, can you provide a plan name?
[AGENT][NEUTRAL] This is a med med link gap policy.
[CUSTOMER][NEUTRAL] Supplemental medical policy, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can you provide your mailing methods to submitting this claim?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII]?
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, thank you. Can you provide that number?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Which fax number you said?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][POSITIVE] OK, thank you, uh.
[CUSTOMER][NEUTRAL] Can you provide your pay ID?
[AGENT][NEUTRAL] 60801
[CUSTOMER][POSITIVE] OK thank you uh.
[CUSTOMER][NEUTRAL] And checking authorization is needed or not needed for this question?
[AGENT][NEUTRAL] No, it's not needed.
[CUSTOMER][NEUTRAL] Other name is not.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I need a confirmation that it did not cover any plan under the physical therapy and the office visit, correct?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] I'm showing that uh the treatment and procedures at the office visit is covered. It's just the copay associated with the physician's charges is not.
[CUSTOMER][NEUTRAL] OK. Uh, can you provide a visit limit?
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] Can you provide a visit limit?
[AGENT][NEGATIVE] I don't understand the question.
[CUSTOMER][NEUTRAL] Uh, can you provide a visit limit?
[AGENT][NEUTRAL] There is no visit limit. It's a dollar amount limit. The outpatient limit is $7350.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, it's based on medical, correct?
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] It's based on medical correct?
[AGENT][NEUTRAL] You said medical necessity?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, yeah, it would have to be medically necessary, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. Can you tell me your name [PII]?
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] Can you spell your name, sorry?
[AGENT][NEUTRAL] My name is [PII]. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Can you spell your first name slowly, spell that?
[AGENT][POSITIVE] Can I do what now? I'm sorry.
[CUSTOMER][NEUTRAL] The first pill.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] The 1.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, thank you. Can you spell your reference number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you tell you call the number.
[AGENT][NEUTRAL] Oh, the reference number, the reference is just my name and today's date and time.
[CUSTOMER][POSITIVE] OK. OK, thank you. Have a nice day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] And