AccountId: 011433970860
ContactId: 0b5bcbab-1230-4b81-aabc-ad1c88f2c283
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456440 ms
Total Talk Time (AGENT): 204182 ms
Total Talk Time (CUSTOMER): 134084 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/0b5bcbab-1230-4b81-aabc-ad1c88f2c283_20250109T13:46_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] Hello, good morning. This is [PII], and I will add a check benefits information, please.
[AGENT][NEUTRAL] OK, [PII], I'm sorry, but how can I help you today?
[CUSTOMER][NEUTRAL] Oh, I would like to check benefits.
[AGENT][NEUTRAL] OK, you're needing benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, so I can help you with that. Will you also need eligibility or only benefits?
[CUSTOMER][NEUTRAL] Um, both.
[AGENT][NEUTRAL] OK, yes, I can help you then with both things. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] 02480051
[CUSTOMER][NEUTRAL] M [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information [PII] 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?
[CUSTOMER][NEUTRAL] Sure. Uh, so the first name is [PII]. Last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so she is a dependent on the supplemental policy and this policy is active. What's an effective date of [PII]?
[AGENT][NEUTRAL] And are you needing inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] OK, so I would like to check the benefits for office visit and for outpatient.
[AGENT][NEUTRAL] I'm sorry, for outpatient and what else?
[CUSTOMER][NEUTRAL] Office y
[AGENT][NEUTRAL] Office visit is what you're needing information for, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] OK, so on this supplemental policy, Sebastian, office visits are not covered.
[AGENT][NEUTRAL] They do have an office treatment writer on the policy, so if there is treatment rendered within the office, then that can be reviewed under the outpatient benefit maximum, which is $750 per covered person per calendar day for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person.
[CUSTOMER][NEUTRAL] OK, thank you. Um, also, um, I got a question for you, um, that is, uh, this is the second insurance, so that means uh 70, I'm sorry, uh $750 will apply for a copays, deductible and co-insurance of the primary insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not a foreign an office visit.
[CUSTOMER][NEUTRAL] Um, yes, I, I know, but not for office visits, but for others, uh, services will apply.
[AGENT][NEUTRAL] For other covered services. Yes, sir, that it would be covered under this plan.
[AGENT][NEUTRAL] Again, as I stated, treatment rendered in the office can fall under that outpatient benefit maximum.
[CUSTOMER][NEUTRAL] OK, and
[AGENT][NEUTRAL] But the office visit itself would not.
[CUSTOMER][NEUTRAL] OK, so in this case, the $750 only uh it's for treatments, right?
[AGENT][NEUTRAL] We can review for treatment that is rendered in the office under that outpatient benefit maximum.
[AGENT][NEUTRAL] There are certain places of service and types of services that are covered under that benefit maximum, however, an office visit is not.
[CUSTOMER][NEUTRAL] OK, an office visit.
[CUSTOMER][NEUTRAL] OK, offices are covered. Thank you. OK, and could you provide me?
[AGENT][NEUTRAL] Yes, sir, and when a claim is
[AGENT][NEUTRAL] Well, first off, when the claim is submitted, if you all submit a claim to APL, you must also submit the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Oh, go ahead.
[AGENT][NEUTRAL] And then we do have a portal Sebastian in which the, once our claim has been processed, you can have access to the explanation of benefits.
[AGENT][NEUTRAL] And and check claim status and that website for us is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK, so.
[AGENT][NEUTRAL] All right. And if you need a reference number?
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Yes, but before that, could you provide me what is the um claims address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] PO Box 248,950
[AGENT][NEUTRAL] Oklahoma City, [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, you told me this number is currently active, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, you have any termination date or there's not?
[AGENT][NEUTRAL] This policy is active.
[AGENT][NEUTRAL] No term date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, so thank you so much for the information. Um, may I have your name and the reference number for this call?
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Again, my name is [PII].
[AGENT][NEUTRAL] And you will use my name along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] OK, try, try see.
[CUSTOMER][POSITIVE] OK, thank you and have a great day.
[AGENT][POSITIVE] Thank you, thanks. I hope you have a great day too, and if that's all I can help you with, thank you also for calling APL.
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.