AccountId: 011433970860
ContactId: 0db93aed-4032-4e18-90d7-78c7d3648940
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 170199 ms
Total Talk Time (AGENT): 88667 ms
Total Talk Time (CUSTOMER): 53819 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/0db93aed-4032-4e18-90d7-78c7d3648940_20250228T21:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII], I'm calling from Doctor [PII]'s office. I need to go over benefits on a patient that has an appointment on Monday.
[AGENT][NEUTRAL] OK, you're needing benefits only or do you also need eligibility?
[CUSTOMER][NEUTRAL] Well, I, I know the patient's eligible. I need benefits to see if the gap plan covers procedures in the office.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And who am I speaking with please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. That's spelled [PII]
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Policy number for the patient is 254-4964.
[AGENT][NEUTRAL] I'm sorry, you're, the line cut out, [PII]. I heard 2544.
[CUSTOMER][NEUTRAL] Right, so it's 254-496-4.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] OK, and 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?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. So on this supplemental policy, the outpatient benefit max per calendar year for covered outpatient services is $1250.
[AGENT][NEUTRAL] With no deductible?
[CUSTOMER][NEUTRAL] OK, so does it cover procedures rendered in the office?
[AGENT][NEUTRAL] It can be reviewed for the treatment, but it does not cover office visits.
[CUSTOMER][NEUTRAL] Right, so it covers the procedures in the office. The patient had some procedures done last month. Could you tell me what's remaining now in that coverage that he has?
[AGENT][NEUTRAL] 01 moment.
[AGENT][NEUTRAL] As of now,
[AGENT][NEUTRAL] He has used $96.24 of his benefits.
[CUSTOMER][NEUTRAL] OK great so um let me have a reference number for the call.
[AGENT][NEUTRAL] Yes ma'am, you would use my name that I gave you along with today's date and make sure Rose, that when you all submit the claim to APL for review to send the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because we do have to [PII].
[CUSTOMER][NEUTRAL] And what's your name again?
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] And then you only check claim status once we have processed the claim in our portal by going to [PII].
[CUSTOMER][POSITIVE] OK great thank you bye bye.
[AGENT][POSITIVE] You are certainly welcome and thank you for calling APL. I hope you have a nice weekend.
[CUSTOMER][POSITIVE] Yes thank you you too bye bye.
[AGENT][NEUTRAL] Bye-bye.