AccountId: 011433970860
ContactId: 0dc543db-f74f-4322-a63b-aef21449bf03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413559 ms
Total Talk Time (AGENT): 181561 ms
Total Talk Time (CUSTOMER): 144697 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/0dc543db-f74f-4322-a63b-aef21449bf03_20250528T16:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Afternoon, [PII]. My name is [PII]. I'm calling from Baptist Outpatient Services, and I was just calling to verify benefits for a patient.
[AGENT][NEUTRAL] OK, [PII], you're needing uh benefits only. Is that correct? or do you also need eligibility?
[CUSTOMER][NEUTRAL] Uh, eligibility as well, please.
[AGENT][POSITIVE] Yes, I can help you with both and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Oh, sure. Uh, that'll be [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, that will be 102.
[CUSTOMER][NEUTRAL] 147,963,100
[AGENT][NEUTRAL] OK, thank you, but [PII], that is not an American public life policy number. I'm not sure what number that is.
[CUSTOMER][NEUTRAL] OK, I'm not sure what.
[CUSTOMER][NEUTRAL] OK, I'm sorry, I got this. I got it mixed up with another policy number. Um, I have it here as 019.
[CUSTOMER][NEUTRAL] 821
[CUSTOMER][NEUTRAL] 55, the letter M for Market, the letter L for Lima.
[CUSTOMER][NEUTRAL] And the number 8, sorry about that.
[AGENT][POSITIVE] OK, thank you, that's OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your uh patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, sure. This will be [PII]. Uh, date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that he is the spouse of 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 again, [PII] inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, uh, outpatient, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So he has an outpatient benefit maximum for covered outpatient services of $500 per calendar day and there is no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] Because this is a supplemental plan to his primary insurance when the claim is submitted to us for review, we will have to have a copy of the primary insurance company's explanation of benefits along with the claim.
[AGENT][NEUTRAL] And then once we have processed the claim here at APL we do have a portal in which you should be able to check claim status and the website for our portal, [PII] is located at [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] [PII], uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there.
[CUSTOMER][NEUTRAL] And uh let's see here and uh they don't have a, oh I'm so sorry, go ahead.
[AGENT][NEUTRAL] Mhm. Go ahead with your question.
[CUSTOMER][NEUTRAL] Um, um, there's not an out of pocket, is there?
[AGENT][NEUTRAL] No, this is not major medical insurance. This is a supplemental policy to the primary insurance, which is why we have to have a copy of their primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. And then uh do you guys have an address for your uh [PII] uh PO box address for claims?
[AGENT][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK perfect and uh is there a payer ID or EDI?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] 60801. OK, perfect.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And uh does it show you the most uh recent um coordination of benefits?
[AGENT][NEUTRAL] There would not be a coordination of benefits on this plan since this is not major medical insurance.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh let's see what else here. There's anything else that I, uh, and uh there's not a group name or group number by any chance is there?
[AGENT][NEUTRAL] There he is. The group number is 24533.
[AGENT][NEUTRAL] And the group name is Zoma, Z O M M A Group LLP.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK. And uh let me see, is there anything else that I may have missed here. Um.
[CUSTOMER][NEUTRAL] OK, I think I have everything. Oh, and um, can I, I'm sorry, I'm sorry, can I get the plan name as well?
[AGENT][NEUTRAL] This is a supplemental supplemental policy called Medlink.
[CUSTOMER][NEGATIVE] I think that's just the last thing I need.
[CUSTOMER][NEUTRAL] Melink.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, the midli supplemental.
[CUSTOMER][POSITIVE] OK, perfect. All right, OK, I think I have everything now and um how do you spell your name just so I have it correctly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and you will use my name along with today's date if you need a call reference number.
[CUSTOMER][NEUTRAL] OK, perfect. Um do you have a last name initial?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And is there anything else, [PII], that I can help you with?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] No, you gave me everything, [PII] I appreciate you.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL. I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] You as well thank you again bye bye.
[AGENT][POSITIVE] Uh. You're welcome. Thank you. Bye-bye.