AccountId: 011433970860
ContactId: 1c6bcca8-6d77-4a5b-9d40-9dc2ad0eeaa3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316429 ms
Total Talk Time (AGENT): 151681 ms
Total Talk Time (CUSTOMER): 112978 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/1c6bcca8-6d77-4a5b-9d40-9dc2ad0eeaa3_20250116T20:28_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII] and I'm calling from the Sloan Center, and it's a therapy center, private agency, and I want to check to see cause they the people seeking services are, you know, they gave me both their insurance which nothing showed up, of course it's early in the year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sometimes that stuff takes a while to get on the computer and but also they gave me this meta gap of APL and so I'm checking on that uh what do you need from me?
[AGENT][NEUTRAL] OK, [PII], are you needing to get eligibility and benefit information for a member?
[CUSTOMER][NEUTRAL] Yes, benefit information for not for me but but for someone who's wants to for for a member, yeah.
[AGENT][NEUTRAL] Yes, for a member.
[AGENT][NEUTRAL] Yes, I can help you with that. And first off, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] The callback number here is let's see, I just have that card in front of me here we go [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Members policy is.
[CUSTOMER][NEUTRAL] Let's see, it says a uh.
[CUSTOMER][NEUTRAL] There's the in hospital benefits certification number, outpatient benefit certification number, and then there's group number which is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the, if you'll notice on the in-hospital or outpatient, the first part of both of those numbers is identical prior to the ML so you can give me either one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, 02032991.
[CUSTOMER][NEUTRAL] ML 8
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And any information, [PII] that I do provide for you 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] The patient's name is [PII]. That is the son of [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is a dependent on the supplemental policy and the supplemental policy is active. What's an effective date of [PII]?
[AGENT][NEUTRAL] And are you needing inpatient, outpatient, or office benefits?
[CUSTOMER][NEUTRAL] It would be outpatient office actually I guess uh you know he's he's calling for therapy.
[AGENT][NEUTRAL] OK, so, um, OK, so just one moment.
[AGENT][NEUTRAL] OK, so on this supplemental policy, [PII] office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He does have an office treatment writer in which treatment could be rendered within the office.
[AGENT][NEUTRAL] Under his outpatient benefit maximum, which is $7350 per covered person per calendar year for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because this is a supplemental policy, [PII], to the primary insurance when the claim is submitted to us for review, we will also have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] All right, OK.
[AGENT][NEUTRAL] And then once we have processed our claim, you should be able to go to our portal to check claim status and also have access to our EOB and our website for our portal is at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] AM Public, so secured [PII] and it's portal at secured.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Ey, mhm.
[AGENT][NEUTRAL] That's our portal. No, you just, no, yeah, our portal web address is [PII], yeah, [PII].
[CUSTOMER][NEUTRAL] Oh, that's just the name, OK.
[CUSTOMER][POSITIVE] Is secured at.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] And as you are certainly very welcome and is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] No, that is all.
[AGENT][POSITIVE] OK, well then thank you again for calling um APL today and I hope you have a wonderful rest of your day.
[CUSTOMER][POSITIVE] I wish you well.
[AGENT][POSITIVE] All right, thank you so much.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.