AccountId: 011433970860
ContactId: 1a388eb3-8450-4deb-b33d-10d0927aa3b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386290 ms
Total Talk Time (AGENT): 147038 ms
Total Talk Time (CUSTOMER): 75408 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/1a388eb3-8450-4deb-b33d-10d0927aa3b8_20250326T20:52_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] Hi, this is [PII] calling from the provider's office for checking benefits and eligibility.
[AGENT][NEUTRAL] OK, and may I know you're needing eligibility and benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the patient's policy.
[CUSTOMER][NEUTRAL] Uh, sorry?
[CUSTOMER][NEUTRAL] Sorry, can you please repeat that?
[AGENT][NEUTRAL] The member's policy number.
[AGENT][NEUTRAL] The member's policy numbers so that I can look up the information?
[CUSTOMER][NEUTRAL] Sure, right.
[CUSTOMER][NEUTRAL] Sure. 02465467.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] 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] Sure, uh, the patient's first name is
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information that I do provide will be a verification of benefits and not a guarantee of pay.
[AGENT][NEUTRAL] She is the spouse of the subscriber supplemental policy, and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Physical therapy outpatient.
[AGENT][NEUTRAL] OK, the outpatient benefit max is $2000 per calendar year for covered outpatient services, and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Uh, once again, before that, you said that this is supplement, no?
[AGENT][POSITIVE] That is correct. This is a supplement.
[AGENT][NEUTRAL] No policy to her primary insurance. Now the claim with APL, [PII], you will also have to send us a copy of her primary insurance company's explanation.
[AGENT][POSITIVE] The benefits as well.
[CUSTOMER][NEUTRAL] OK, the 2000.
[CUSTOMER][NEUTRAL] It's for uh
[CUSTOMER][NEGATIVE] Out of pocket, no.
[AGENT][NEUTRAL] That's the benefit maximum for outpatients.
[CUSTOMER][NEUTRAL] OK, then its maximum limit, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this will, uh, follows the primary guidelines, no?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] From the [PII] how many has been used?
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] For this calendar year as of now there has not been any benefits used.
[CUSTOMER][NEUTRAL] And can you please spell out your name?
[AGENT][NEUTRAL] [PII]. My name and today's date will be your call reference number.
[AGENT][NEUTRAL] And if you all do file the claim.
[CUSTOMER][NEUTRAL] Yes, uh, before you.
[AGENT][NEUTRAL] Once we have processed the claim here at APL, we do have a portal, [PII] that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Uh, can you please help me the client's mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. That's right. [PII].
[AGENT][POSITIVE] That is correct. Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] [PII]. OK. [PII], no effective date.
[AGENT][NEUTRAL] That is the effective date. There is no termination date. The policy is active.
[CUSTOMER][POSITIVE] OK, sir. Thank you so much.
[AGENT][POSITIVE] You are certainly very welcome. And is there anything else that I can help you with this afternoon?
[CUSTOMER][POSITIVE] Uh, no, I got all that information. Thank you so much.
[AGENT][POSITIVE] OK, well you're very welcome and thank you.
[AGENT][POSITIVE] And for calling APL, I hope you have a nice uh rest of your day, man.
[CUSTOMER][POSITIVE] Yes, have a great day.
[AGENT][POSITIVE] Thank you, you too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye for now.