AccountId: 011433970860
ContactId: 12821cac-0034-4eb7-815c-a00e52ea0f91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431859 ms
Total Talk Time (AGENT): 222251 ms
Total Talk Time (CUSTOMER): 127206 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/12821cac-0034-4eb7-815c-a00e52ea0f91_20250305T15:31_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, good morning. Uh, my name is [PII]. I'm calling from a provider's office to verify benefits on a member, please.
[AGENT][NEUTRAL] OK, [PII], you're needing benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and [PII], will you also need eligibility or do you only need benefits?
[CUSTOMER][NEUTRAL] Both.
[AGENT][NEUTRAL] You do need both? OK. Yes, I can help you with both. And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's 01691.
[CUSTOMER][NEUTRAL] 302 M as in Mary, L as in Laura number 8.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and any information that I do provide for you?
[CUSTOMER][NEUTRAL] It's a real
[AGENT][NEUTRAL] [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now the policy number that you provided for me that is an old policy number that is no longer active.
[AGENT][NEUTRAL] This policy number you provided for me actually termed as a 12-1-2020.
[AGENT][NEUTRAL] But she does have another policy, [PII] that is active, and if you'll give me just one moment, I'll provide you that information.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the current active policy that she has is 231.
[AGENT][NEUTRAL] 267 7.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] This supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need for her, [PII] inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] I need, um, well I need outpatient benefits um.
[CUSTOMER][NEUTRAL] She's going to, she's coming to the office to do an endoscopy procedure, um, it will be done in an office setting.
[AGENT][NEUTRAL] OK, all right, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I read that.
[CUSTOMER][NEUTRAL] They have yeah you have.
[AGENT][NEUTRAL] OK, so on her policy, she does have an office treatment writer.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And her outpatient benefit maximum is $4000 per calendar year per covered person for covered outpatient services and there is no.
[CUSTOMER][NEUTRAL] How much is it? I'm sorry?
[AGENT][NEUTRAL] 4000.
[AGENT][NEUTRAL] Per calendar year.
[AGENT][NEUTRAL] For covered person for covered outpatient services.
[CUSTOMER][NEUTRAL] And what's the remaining on that?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and as of now, she has not used any of her benefits for this calendar year at this time.
[CUSTOMER][NEUTRAL] 0.
[AGENT][NEUTRAL] For this calendar year, that is correct as of now.
[AGENT][NEUTRAL] Now because this is a supplemental policy to her primary insurance, [PII], when the claim is filed with APO, we will also need a copy of her primary insurance company's explanation of benefits.
[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 our claim status and have access to our explanation of benefits and the website for our portal is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'm so sorry because I can I can barely hear you. I don't know what happened, um, and what's, um, what's the amount that she has again? I'm so sorry about that.
[AGENT][NEUTRAL] Can you hear me OK?
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] I, I hear you, so yeah, I hear you sort of. I just, you, you.
[AGENT][NEUTRAL] Yeah, I don't.
[AGENT][NEUTRAL] I don't know why. I mean, I'm, I'm not sure what the issue is. I'm so sorry. The outpatient benefit maximum.
[CUSTOMER][NEUTRAL] No, yeah, yeah, it's yeah it's.
[AGENT][NEUTRAL] Per covered person per calendar year for covered outpatient services is $4000 and there is no outpatient deductible per covered person per calendar year. As of now, no benefits have been used for this calendar year.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] 400.
[CUSTOMER][NEGATIVE] You see, you see, you see, you see why I didn't understand what you said, that's why.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] OK, and that does cover surgery in office, uh, right?
[AGENT][NEUTRAL] She does have an office treatment writer.
[AGENT][NEUTRAL] That yes this we can review this under her outpatient benefit. If you weren't able to hear me when the claim is submitted to [PII] [PII], you will also need to send us a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, yes, we, we always, we always, uh, process it like that. Um, can I please have your name and if there is a reference number for the call, thank you so much for your help.
[AGENT][NEUTRAL] As well.
[AGENT][NEUTRAL] You're welcome. Again, you would use my name that I gave you along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] OK, and what is your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][POSITIVE] Yes ma'am. And is there anything else that I can help you with this morning, [PII]?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] No, that's all I needed. Thank you so much for your help, [PII]. Have a good rest of your day.
[AGENT][POSITIVE] Yes ma'am, you too, [PII], and thank you again for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you bye bye you too.
[AGENT][POSITIVE] You're welcome. Bye bye.