AccountId: 011433970860
ContactId: 16d19aa4-8153-4120-b28e-0fbb07965291
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407000 ms
Total Talk Time (AGENT): 203173 ms
Total Talk Time (CUSTOMER): 138964 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/16d19aa4-8153-4120-b28e-0fbb07965291_20250527T12:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. I'm calling from a doctor's office. I'd like to verify benefits for a patient please.
[AGENT][NEUTRAL] OK, so you're only needing benefits and not eligibility, is that correct?
[CUSTOMER][NEUTRAL] Oh please.
[AGENT][NEUTRAL] You do need both. Is that correct?
[CUSTOMER][NEUTRAL] Yes, both of them please.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you, and [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] I will do something
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 02518294.
[AGENT][POSITIVE] OK [PII], thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information [PII] that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yes, I'm sorry. One second. The patient is JC2 [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Oh, you're fine.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um, and I think she's, um, like refilling some of the.
[AGENT][NEUTRAL] OK, so again, any information that's provided, [PII] will be a verification of benefits and not a guarantee of payment. I do show that he is a dependent on the supplemental policy, and it is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, fees and you said this will be a secondary and what was the um coverage date beginning date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. So now on off, is this for an office visit? Is that correct?
[CUSTOMER][POSITIVE] Yes, and for procedures in an office setting and we can do that please.
[AGENT][NEUTRAL] OK, so the office visit is not covered.
[AGENT][NEUTRAL] We can review treatment that's rendered in the office. Uh, give me just one moment, please.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is.
[AGENT][POSITIVE] One second, I'm so sorry.
[AGENT][NEUTRAL] Bear with me just one second, please, right now.
[CUSTOMER][NEUTRAL] It's OK mhm.
[CUSTOMER][POSITIVE] No worry, no worry, no problem.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Was it
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] I want to double check one thing for you.
[CUSTOMER][NEUTRAL] No, I think.
[AGENT][NEUTRAL] OK, so for the outpatient sickness and accident uh benefits for treatment in the office, that can be reviewed under that outpatient benefit maximum which is $2,025 per cover person and this is a per plan year.
[AGENT][NEUTRAL] Policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And again that benefit max is $2,025.
[AGENT][NEUTRAL] Now, because it is a supplemental policy.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] When the claim is submitted to APO for review, we must also receive a copy of the primary insurance company's explanation of benefits along with the claim 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 arena and the website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK, so let me repeat, so for the this there is no coverage, right? But for the procedures, mhm.
[AGENT][NEUTRAL] Office visits are not covered. Mhm.
[CUSTOMER][NEUTRAL] And for procedures, I mean like any skin testing, the maximum is $2,025 per person per plan year, right?
[AGENT][POSITIVE] That is correct, $2,025. That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Good, I have a question. So based on the primary insurance of the patient, uh, he has a co-payment. Will the secondary APL will take care of that co-payment then?
[AGENT][NEUTRAL] Again, as I stated, I cannot guarantee payment. I can only provide you with the benefit information is. We'll have to receive the claim along with the primary explanation of benefits for review.
[CUSTOMER][NEUTRAL] Mm mm got it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK and is there any accumulations on the on the out of pocket for this member?
[AGENT][POSITIVE] I can check that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And for this for this calendar year as of now, no, ma'am.
[CUSTOMER][NEUTRAL] OK, good, thank you [PII]. I have a reference number for the call please.
[AGENT][NEUTRAL] Well, yeah.
[AGENT][NEUTRAL] You would actually use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you very much have a nice day.
[AGENT][POSITIVE] Well, I hope you have a nice day too. That's all I can help you with, and thank you again for calling APL today [PII].
[CUSTOMER][POSITIVE] Mm thank you bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] It's