AccountId: 011433970860
ContactId: 10cc8619-8980-4354-ad85-4cb2f3883a67
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 525150 ms
Total Talk Time (AGENT): 186416 ms
Total Talk Time (CUSTOMER): 94588 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/10cc8619-8980-4354-ad85-4cb2f3883a67_20250227T20:57_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 [PII], my name is [PII]. I'm calling from our provider's office. I needed to check on um eligibility and an effective date for a patient, please.
[AGENT][NEUTRAL] OK, [PII], you're only needing eligibility information. You do not need benefits as well. Is that correct?
[CUSTOMER][NEUTRAL] Um, I, well, eligibility, I guess benefits, um, the patient has called in and said that this is their secondary insurance and we're not really quite sure if it's gonna cover an offices and what kind of coverage they have.
[AGENT][NEUTRAL] Yes ma'am, well I can help you with this, and what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] It is 650641.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] And any information that I do provide for you today, [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] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] So I do show she is the spouse of the subscriber on this limited benefit plan and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And you said you were
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] needing benefits to see if an office visit is covered. Is that correct under this policy?
[CUSTOMER][NEUTRAL] Well, um, you said that this is a limited benefit plan, so what does it cover?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] This plan only covers specific services for certain dollar amounts for a certain number of days, so what type of benefits are you needing? inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, it's just, no, it's just a professional visit, um, with the, um, a provider.
[AGENT][NEUTRAL] OK, so let me check that for you. Let me get her benefits pulled up on this plan.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It's just taking a moment to load all this information on this policy. Thank you.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] It's still working on loading it. I can't just for thank you for your patience.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, let me refresh this because it's almost like it's just not gonna load. So again, thank you so much for your patience.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so do you mind letting me place you on a brief hold, [PII]?
[CUSTOMER][NEUTRAL] No, that's fine.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Currently no agents staffed. Goodbye.
[AGENT][NEUTRAL] OK, [PII], thank you. So maybe finally um it's pulled up. OK, so for an office visit, the benefit on this plan is $25 per visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and let's see, I have a claims address of [PII].
[AGENT][NEUTRAL] No, let me give you an updated address, [PII], that used to be our address, but we are no longer using that PO box, so the correct [PII] now for claims is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and do you accept claims electronically?
[AGENT][NEUTRAL] Yes, our electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And then [PII], once the claims, once we have processed claims, we do have a portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK, and then what is your timely filing?
[AGENT][NEUTRAL] And again,
[AGENT][NEUTRAL] There is no timeline filing?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on this plan again that's $25 per visit and it's a max benefit per calendar year of $350.
[CUSTOMER][NEUTRAL] Max of 350 OK.
[AGENT][NEUTRAL] Total. Mhm. For, for everyone.
[CUSTOMER][NEUTRAL] Total, OK.
[CUSTOMER][NEUTRAL] Are you able to tell me if they've met their max for 2024?
[AGENT][NEUTRAL] Uh, just one moment.
[AGENT][NEUTRAL] So this is for pre prior data service?
[CUSTOMER][NEUTRAL] Yes, it's they just, um, she just called in February and gave us this information, but it was for an [PII] data service of [PII].
[AGENT][NEGATIVE] No, it has not been met. I mean, it has not been maxed for 2024.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I will get this claim sent out thank you.
[AGENT][POSITIVE] OK, well, you're certainly very welcome and again, if that is all I can help you with, [PII], thank you for calling APL and I hope you have a very nice evening.
[CUSTOMER][POSITIVE] Thank you alright bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.