AccountId: 011433970860
ContactId: 0d4c9530-9a1c-48e1-b787-dccaee80a1e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319899 ms
Total Talk Time (AGENT): 160589 ms
Total Talk Time (CUSTOMER): 114970 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/0d4c9530-9a1c-48e1-b787-dccaee80a1e0_20250402T13:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. My name is [PII]. I'm calling from Texoma Medical Center. I'm trying to verify patients coverage. They did give us this as a secondary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], uh, you're needing to verify benefits or eligibility or both?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Exactly benefits eligibility mhm.
[AGENT][NEUTRAL] Both.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][POSITIVE] Ma'am, I can help you with that.
[CUSTOMER][NEUTRAL] Just call back
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] We have 021-68473.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the excuse me, the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then the information that I do provide for you today, uh, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, any information
[CUSTOMER][NEUTRAL] OK, we have [PII] or [PII]. His date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show he is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Both he had one inpatient visit on [PII] and then another one on [PII] as an outpatient visit.
[AGENT][NEUTRAL] OK. And, OK, so an outpatient office visit?
[CUSTOMER][NEUTRAL] He had both. He had inpatient in November and then he had outpatient in in December.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] I want to make sure I'm the outpatient, oh, not office visits. You're needing outpatient benefits. OK.
[CUSTOMER][NEUTRAL] Hospital ER.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, no, yes, exactly, both hospital.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so the inpatient benefit mas, excuse me.
[CUSTOMER][NEUTRAL] Facility.
[AGENT][NEUTRAL] Per calendar year for covered outpatient services is 3900.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the, with no deductible and the outpatient is the same.
[CUSTOMER][POSITIVE] Perfect, 3900 max got it.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me look at something. Give me just a second.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] That is, that is correct. Now when you all do file a claim with us on this policy, [PII], because it is a supplemental policy, we would have to have a copy of the primary insurance company's explanation of benefits, uh huh, as well, and then once we've processed our claims, uh, we do have a portal in which you should be able to check claim status by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] [PII] mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me just make sure I got the first right. You said [PII]. OK, [PII].
[AGENT][POSITIVE] Correct, that is correct. Uh-huh. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And for the
[CUSTOMER][NEUTRAL] OK, now are the claims for paper claims is the uh is there a specific claims mailing address?
[AGENT][NEUTRAL] If you're going to be mailing them, it's PO Box 248.
[CUSTOMER][NEUTRAL] Like a PO box?
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] That's Oklahoma City, Oklahoma.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 8950 for the plus 4 got it and is there any electronic payer ID?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] OK, perfect. 60801 alrighty thank you so much, [PII] for your time and help. Also, do you provide reference numbers for the call?
[AGENT][NEUTRAL] 00.
[AGENT][POSITIVE] Yes, and you will actually just use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect, thank you again, [PII] you have a great day. Enjoy the rest of your day.
[AGENT][POSITIVE] Well, uh, yes, ma'am. I hope you do too, [PII] and if that is all I can help you with, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Yes, thank you so much mhm bye bye.
[AGENT][POSITIVE] You're very welcome. Bye-bye.