AccountId: 011433970860
ContactId: 0a21b054-2aab-4a0c-b2c2-42dacdd736a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347600 ms
Total Talk Time (AGENT): 171646 ms
Total Talk Time (CUSTOMER): 84140 ms
Interruptions: 2
Overall Sentiment: AGENT=1.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/0a21b054-2aab-4a0c-b2c2-42dacdd736a3_20250325T18:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL this is [PII]. How can I help?
[CUSTOMER][NEUTRAL] Hi, I'm calling to get a um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understanding of a member's benefits.
[AGENT][NEUTRAL] OK, so you're needing only benefit information for number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] My policy number 02506280.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] One moment, please. And you said that was, OK, give me, yes, ma'am. Just one moment.
[CUSTOMER][POSITIVE] Oh thank you I'm sorry.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today would 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] Um, it's [PII]. The last name is [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, thank you. So yes, ma'am, I do show she is the subscriber on the supplemental policy. So what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] I'm it's office. I'm calling from an OBGYN and she previously had a sonogram that she's wanting us to submit.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] OK, so on the supplemental policy her outpatient benefit maximum for covered outpatient services is $7500 per calendar year.
[AGENT][NEUTRAL] Now, office visits are not covered, but we can review treatment done within the office.
[CUSTOMER][NEUTRAL] OK. And if she um is needing to file a claim on her own behalf, she would just contact her policy?
[AGENT][NEUTRAL] Well, it has, because this is a supplement to her primary insurance, it would have to be.
[CUSTOMER][NEUTRAL] I'm sorry, your phone went out.
[AGENT][NEUTRAL] She filed with her primary insurance company first, regardless of.
[AGENT][NEUTRAL] It would have to be filed with her primary insurance company.
[CUSTOMER][NEUTRAL] It already has.
[AGENT][NEUTRAL] Mhm. OK. So then, because we will have to have a copy of her primary insurance company's explanation of benefits along with the claim.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Regardless of who files it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you all do not file? Are you, are you, um, are you asking me if you all have to file it or are you telling me that y'all don't file for supplements?
[CUSTOMER][NEUTRAL] Well, based upon her benefits, we
[CUSTOMER][NEUTRAL] Right, we don't. So normally most people who have supplements are through Medicare, so it's automatically filed on their behalf.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, and then of course based upon her explanation of benefits we had already advised her it was not something that we would file through our office.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, so she, when she filed, uh, obviously she would submit a claim form with the itemized bill, including the diagnosis code and a copy of her primary insurance company's explanation of benefits. Again, we can review the procedure that was done, but the office visit is not covered.
[CUSTOMER][NEUTRAL] Do you cover diagnostic X-rays in office?
[AGENT][NEUTRAL] Again, treatment rendered within the office can be reviewed under the outpatient benefit that I provided for you. It's just the office visit is not covered. The visit charge itself is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there a um reference number to the call?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[AGENT][NEUTRAL] And [PII], should you all end up filing a claim with APL, we also have a
[AGENT][NEUTRAL] Portal
[CUSTOMER][NEUTRAL] I'm sorry, your phone went out again.
[AGENT][NEUTRAL] In which you can check claim status you should be.
[AGENT][NEUTRAL] Yes, and I don't know why it's doing that. I'm so sorry.
[AGENT][NEUTRAL] Uh, we have a portal in which once a claim has been processed by APL that you should be able to check claim status in. So if you will end up filing this for her, our portal website that you can sign up for is secured.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and I'm sorry, your first name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. I appreciate it.
[AGENT][POSITIVE] Well, you're very welcome. Yes, ma'am. And is there anything else, [PII] that I can help you with?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] OK, well then thank you again for calling APL and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Yes ma'am, thank