AccountId: 011433970860
ContactId: 0b61424f-2465-428f-af1b-cd048765c3c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322239 ms
Total Talk Time (AGENT): 148861 ms
Total Talk Time (CUSTOMER): 56299 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/0b61424f-2465-428f-af1b-cd048765c3c5_20250214T15:25_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, my name is [PII]. I'm calling from Lincoln Road Dermatology checking your eligibility and benefits, please.
[AGENT][NEUTRAL] OK, you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits for a member. Is that also correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Oh yeah, it is.
[CUSTOMER][NEUTRAL] 02571037.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] So 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 please and their date of birth?
[CUSTOMER][NEUTRAL] It'll be for [PII].
[CUSTOMER][NEUTRAL] Her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just one moment please.
[AGENT][NEUTRAL] OK, and what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Oh, office, office.
[AGENT][NEUTRAL] Is this for an office visit? OK. So on this supplemental policy, office visits are not covered.
[CUSTOMER][NEUTRAL] Oh, obviously it's my car.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Oh, I see. Alright, thank you so much, ma'am. Can I have your reference number please?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you, along with today's date. And let me check one more benefit for you on her policy. So just one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK. So that is correct. Of visits are not covered. Now, should she have
[AGENT][NEUTRAL] A procedure done?
[AGENT][NEUTRAL] You know, some type of treatment that is rendered within the physician's office, then [PII] we could review that under her outpatient benefit, Max.
[AGENT][NEUTRAL] And the outpatient benefit maximum on this particular member's policy is going to be $3000 per covered person for covered outpatient services for calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With no deductible.
[AGENT][NEUTRAL] And if you end up filing a claim with APL, then you will also need to send us a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed the claim with APL we do have a portal that you should be able to check claim status in and also have access to your our explanation of benefits rather, and our portal website is located at [PII].
[CUSTOMER][NEUTRAL] Oh, all right, thank you. So let me, uh, I wanna make sure office but outpatient service like surgeries, right?
[CUSTOMER][NEUTRAL] They're covered, but not the offices.
[AGENT][NEUTRAL] Yes, there, or if she had some type of correct. The visit is not covered. We can review treatment that's rendered in the doctor's office.
[AGENT][NEGATIVE] But not the office visit itself. That would not be covered.
[AGENT][NEUTRAL] Are you still there, [PII]?
[CUSTOMER][NEUTRAL] Oh yes, ma'am.
[AGENT][NEUTRAL] Oh, OK. I'm sorry. It just sounded like the call may have dropped.
[CUSTOMER][NEUTRAL] Uh, I just wanna make sure I got the notes correctly. All right, then it's already, yeah, I got the notes correctly.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] All right then thank you. Bye bye.
[AGENT][NEUTRAL] Is there
[AGENT][POSITIVE] OK, well if that's all I can help you with, and thank you again for calling APL and I hope you have a great weekend.
[CUSTOMER][POSITIVE] Alright thank you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you.