AccountId: 011433970860
ContactId: 0c84f732-2988-4476-b257-a4539eb5e96d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409760 ms
Total Talk Time (AGENT): 201217 ms
Total Talk Time (CUSTOMER): 120635 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/0c84f732-2988-4476-b257-a4539eb5e96d_20250117T15:09_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. My initial is [PII], and I'm calling from provider's office to get the benefits for a member.
[AGENT][NEUTRAL] OK, [PII], you're needing benefit information for a member, is that correct?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Did you say that you are needing to get benefit information for a member?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, what is the extension?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] OK. So it is.
[AGENT][NEUTRAL] Uh, the policy number?
[CUSTOMER][NEUTRAL] 019
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It is, OK, I will repeat it. It is 0191282 M as in Mary, L as in Lima, 8.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] OK, we're missing a number somewhere in there. Um, give me just one give me the number again.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can you please repeat what number you have so that I can check in my system that.
[AGENT][NEUTRAL] 0191282 and but that was before the M.
[AGENT][NEUTRAL] I need the first part of the number.
[CUSTOMER][NEUTRAL] Oh, OK. So,
[CUSTOMER][NEUTRAL] It is 019.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 128
[CUSTOMER][NEUTRAL] 72
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] One moment, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information 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 date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. So I do show that he is the subscriber on the supplemental policy. The supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] For office visit?
[AGENT][NEUTRAL] I'm sorry, did you say an office visit?
[CUSTOMER][NEUTRAL] OK. So, for this number, I have a particular procedure code which is going to be performed in the office setting. So uh by a specialist. So I need benefit for that.
[AGENT][NEUTRAL] OK, for a procedure done in the doctor's office, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so on this policy, the supplemental policy, Olivia does not cover office visits. However, it does have an office treatment rider.
[AGENT][NEUTRAL] On the policy, which can be reviewed under the treatment can be reviewed under the outpatient benefit.
[AGENT][NEUTRAL] And the outpatient benefit maximum is $250 per covered person per calendar day for covered outpatient services, and there is no outpatient deductible per cover person per calendar day.
[CUSTOMER][NEUTRAL] OK. And is there any out of pocket or not?
[AGENT][NEUTRAL] This is not a primary, we are not a major medical insurance. This is only supplemental, so there's no copay.
[CUSTOMER][NEUTRAL] Yeah. OK. So I just wanna know that.
[CUSTOMER][NEUTRAL] OK. Uh, this insurance will cover primary insurance co-pay or not?
[AGENT][NEUTRAL] Again, I cannot I cannot guarantee payment. I can only verify the benefits and on this policy again, office visits are not covered.
[AGENT][NEUTRAL] The policy does have an office treatment rider that we can review the treatment. Under that outpatient benefit maximum per calendar day for covered outpatient services, and that benefit amount is $250.
[AGENT][NEUTRAL] And there is no outpatient deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, uh, it is covered $250 for the uh uh treatment for the outpatient, right?
[AGENT][NEUTRAL] That is the benefit maximum on this policy. We will have to review the claim and we will also need for you to send the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well for review.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Not an issue. Can, can you please provide me plant type for this number?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Supplemental medin.
[CUSTOMER][NEUTRAL] It is supplemental and then?
[AGENT][NEUTRAL] The theta is Medlink M E D L I N K.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once we have processed our claim, you may check claim status for APL by going to our portal website at secured.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Am public.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Can you please spell out your name for me?
[AGENT][NEUTRAL] Yes, because my name and today's date will be your call reference number and it is spelled [PII]
[CUSTOMER][POSITIVE] OK. Thank you so much for giving me that information. That's all for the day. Have a good day. Bye-bye for now.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope you have a nice day and a nice weekend as well.