AccountId: 011433970860
ContactId: 1c90ceee-66c8-48d9-9924-0f51d92860f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295920 ms
Total Talk Time (AGENT): 135156 ms
Total Talk Time (CUSTOMER): 114991 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/1c90ceee-66c8-48d9-9924-0f51d92860f1_20250423T20:20_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, uh [PII], this is [PII] Um my last name first initial is [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. I'm calling for medical benefits and eligibility for a patient please.
[AGENT][POSITIVE] Yes ma'am. How can I help you today?
[AGENT][NEUTRAL] OK, you're needing eligibility and benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It is 01868783.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hold up.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I'm just seeing it. Well, give me one second. I'm so sorry. One of my screens froze on me. I apologize.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Why? I don't know.
[CUSTOMER][NEUTRAL] So allow me a few minutes and I'll.
[CUSTOMER][NEGATIVE] No, no, he did the same thing and it went blank, no.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, because normally they're knowing, but you.
[CUSTOMER][NEUTRAL] Yeah, I had to keep checking back.
[AGENT][NEUTRAL] OK, and just seeing any information that I provide for you today would be a.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Verification of benefit, not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK. Um, the patient.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Uh sorry, the patient is [PII] 61262. Patients coming in for a home sleep study for CPT code 95806 home sleep study.
[AGENT][NEUTRAL] OK. She is the supplement, she is the subscriber on the supplemental policy. This policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And she has an outpatient benefit maximum of $2550 per calendar year for covered outpatient services and there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the 2500 is an out of pocket?
[AGENT][NEUTRAL] Because this is a
[AGENT][NEUTRAL] Her 2550 is her maximum benefit on this supplemental policy.
[AGENT][NEUTRAL] See for covered outpatient services for calendar year.
[CUSTOMER][NEUTRAL] Oh, it's her maximum.
[CUSTOMER][NEUTRAL] Sorry, you're like cutting in and out so it's her maximum benefit is 2500.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] $2550.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And how much have they met so far?
[AGENT][NEUTRAL] $5.80.
[AGENT][NEUTRAL] 1 cents.
[CUSTOMER][NEUTRAL] Oh, you cut out again. Can you say that again?
[AGENT][NEUTRAL] She's used $5.
[AGENT][NEUTRAL] She is $5.81.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Of the calendar your maximum benefits.
[CUSTOMER][NEUTRAL] Got it $5.81. OK, um, so do you guys cover the, um, like because you guys are secondary, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I can't, again, I can't guarantee that we will have to receive the claim.
[AGENT][NEUTRAL] That, that is correct. So we will have to receive the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Along with the primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] OK, so it's not a guarantee of benefits.
[AGENT][NEUTRAL] That is correct. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Um, and she's currently, currently active. Do you guys require authorization for the 958-006 or since you guys are secondary, Probably not.
[AGENT][NEUTRAL] We don't require prior to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No that's required.
[AGENT][NEUTRAL] No, there is no prior authorization with it. Correct.
[CUSTOMER][NEUTRAL] OK, uh, reference number please.
[AGENT][NEUTRAL] Would be my name and today's date and just seeing if you will for her with us once the claim has been processed by APO we do have a portal in which you should be able to check claim status and our portal website is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Well, you're welcome. And is there anything else I can?
[CUSTOMER][POSITIVE] No ma'am thank you bye bye.