AccountId: 011433970860
ContactId: 1b9d05d6-18bd-4435-b4c9-342b6c93e01d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304339 ms
Total Talk Time (AGENT): 144792 ms
Total Talk Time (CUSTOMER): 69400 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/1b9d05d6-18bd-4435-b4c9-342b6c93e01d_20250115T20:01_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] Hello [PII], this is [PII]. I'm calling from physical therapy now to check eligibility and benefits for a member. Can you please help me?
[AGENT][NEUTRAL] OK [PII], you're needing eligibility and benefit information on a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, I can help you with that.
[AGENT][NEUTRAL] And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] It is 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02131334 M as in Mike L as in Lima number 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] OK, and then the information [PII] I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Date of birth.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And again, what type of benefit information did you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Yes, it's outpatient. She has uh Cigna as primary, and Cigna has a copay. And she wanna know if you guys cover it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] And again you said this is you're needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yeah, yes, it's for physical therapy.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $1500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, with API she has 1500.
[AGENT][NEUTRAL] For covered outpatient services, yes, sir, per calendar year. And because this is a supplement, [PII], to your primary insurance when the claim is submitted to APL, we will also have to receive a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Per year.
[CUSTOMER][NEUTRAL] OK, of of the 1500.
[CUSTOMER][NEUTRAL] Is, is any accumulation?
[AGENT][NEUTRAL] And you are referring to this calendar year?
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so give me a moment, I can catch that for you.
[AGENT][NEGATIVE] As of now for [PII], there have not been any benefits used.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat?
[AGENT][NEGATIVE] As of now, there have been no benefits for this calendar year used.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it is the remaining is 1500, yeah.
[AGENT][NEUTRAL] As of now, it is, yes.
[CUSTOMER][NEUTRAL] OK, OK, can you provide me your name and a reference number please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, my name is [PII]. You will use my name along with today's date as your call reference number and then [PII], once we have processed the claims with APL you may access the explanation of benefits.
[AGENT][NEUTRAL] And check claim status.
[AGENT][NEUTRAL] By going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. And can I help you with anything else today?
[CUSTOMER][POSITIVE] Uh, no, that's all. Thank you. Have a nice day.
[AGENT][POSITIVE] OK. Well, you're very welcome and thank you again for calling APL. I hope that you have a nice afternoon also.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mm, bye-bye.