AccountId: 011433970860
ContactId: 0ff4f24f-8674-4a94-a70d-ba509b300203
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264869 ms
Total Talk Time (AGENT): 133702 ms
Total Talk Time (CUSTOMER): 50484 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/0ff4f24f-8674-4a94-a70d-ba509b300203_20250313T15:13_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, [PII], my name is [PII]. I'm calling to see if a patient has coverage for bariatric surgery.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify benefits for bariatric surgery. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 02587817
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information, [PII] 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 date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Excuse me. Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and [PII], um, I do show that she is the spouse of the subscriber on the supplemental policy. This supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And again, this is a supplement to the primary insurance.
[AGENT][NEUTRAL] And for the benefit information, is this for inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $6000.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And because this is a supplemental policy to our primary insurance, Chantelle that helps with co-pays, deductibles and co-insurance amounts of coverage services, we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for reviews.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And also once we have processed our claim here at APL we do have a portal in which you should be able to check claim status by going to secured. [PII].
[AGENT][NEUTRAL] And I'm sorry I gave you some incorrect. There is an outpatient deductible, I'm so sorry, on this policy, and the outpatient deductible is $100.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I totally overlooked that 1st, 1st part of that number. I'm so sorry.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] I need to call the patient to see what her primary insurance is because if we don't have that card.
[AGENT][NEUTRAL] And do you
[AGENT][NEUTRAL] And anything
[AGENT][NEUTRAL] Yes, and this is only a supplement. We're not a major medical insurance and anything not covered by the primary also would not be covered by APO.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. I'll, I'll call the patient.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you're welcome. So again, is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No ma'am you have a good day.
[AGENT][POSITIVE] Well, thank you so much. I hope you have a great day too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Now have 24/7 secure online access to find a doctor, check your personal health information, and much more. Visit our website to create an account. [PII].