AccountId: 011433970860
ContactId: 205b5e2a-40ef-40b0-8512-f1546371d19e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 527159 ms
Total Talk Time (AGENT): 281473 ms
Total Talk Time (CUSTOMER): 130660 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/205b5e2a-40ef-40b0-8512-f1546371d19e_20250219T15:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I am just trying to uh verify benefits and eligibility for this patient.
[AGENT][NEUTRAL] OK, you're needing to verify benefits and eligibility information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[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] OK, [PII], thank you and your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and your members of the patient's policy number rather.
[CUSTOMER][NEUTRAL] 02586149
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that Mr. [PII] is a subscriber on this limited benefit plan and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office? Again, this is not a major medical plan. This is a limited benefit plan.
[CUSTOMER][NEUTRAL] So, um, we try to gather all the benefit information in case, so he's trying to get established primary care so just in case we need to bill multiple things so I have I'm uh needing primary care office visit, specialist office visit and then urgent care office visit.
[CUSTOMER][NEUTRAL] And then labs and diagnostics.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, lab work is not covered under this policy?
[AGENT][NEUTRAL] For outpatient accident and sickness treatment benefit for urgent care facility, that is a $50 per day, maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On a physician's office, it's not broken out into specialist or PCP. His physician's office benefit is $50 per day, maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] I'm sorry, say that one more time.
[AGENT][NEUTRAL] The physician's office benefit is $50 per day, maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK and so um that includes specialists.
[AGENT][NEUTRAL] That is correct. It's, again, his benefit for a physician's office visit is not broken out into categories. It is only one single benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about diagnostic, like any X-rays, ultrasounds, anything like that? That's not included either?
[AGENT][NEUTRAL] He, he does have a diagnostic testing benefit for certain diagnostic tests. Give me just one moment and I can tell you what those are.
[AGENT][NEUTRAL] OK, so the diagnostic tests that are covered under his policy would be for a level one test is an MRI CAT scan.
[AGENT][NEUTRAL] An RAIU, a CT, and a PET scan.
[AGENT][NEUTRAL] And that diagnostic testing benefit would be $100.
[AGENT][NEUTRAL] And a maximum of one day per calendar year per covered person.
[CUSTOMER][NEUTRAL] Oh wait, 100 max.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the benefit is $100 per day, $100 per day, maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If he had to have an advanced or follow-up diagnostic test on this policy, uh, give me one moment. I can tell you the tests that are covered. That would include an angiogram, a barium minima, or lower GI series, myelogram, nuclear stress test, arteriogram, barium swallow upper GI series, a sleep study, or a transesophageal echocardiogram, a TEE.
[AGENT][NEUTRAL] And that benefit on this policy would be for those tests $25 per day maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, and then how does multi plan play in because the uh the patient said that multi plan is on this card?
[AGENT][NEUTRAL] Multiplan is the network that this policy is associated with and if you have any questions regarding your providers in the network, then I can provide you the phone number, um, Latonya for multiplan and I can also connect you with them as well.
[CUSTOMER][NEUTRAL] So yeah
[CUSTOMER][NEUTRAL] Oh, I don't need to do that. We do accept multi plans, but we're not billing multi plan, right?
[AGENT][NEUTRAL] Oh, OK. OK.
[AGENT][NEUTRAL] The claims are submitted, that is correct. Mhm.
[CUSTOMER][NEUTRAL] We're billing IMA Inc.
[AGENT][NEUTRAL] That is their clearing.
[CUSTOMER][NEUTRAL] What is IMA stand for?
[AGENT][NEUTRAL] Honestly, I, it's, uh, hm, I don't know.
[AGENT][NEUTRAL] I, I can't answer that question. Sorry.
[CUSTOMER][NEUTRAL] OK, um, OK, but this is not an open access plan it's an actual insurance it's um a plan, an insurance plan that utilizes multi plan, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] Correct. This is a limited benefit plan. It is not major medical insurance. Mhm.
[CUSTOMER][NEUTRAL] Limited benefit plan, OK.
[CUSTOMER][NEUTRAL] Is there a group number that we should list when we're billing?
[AGENT][NEUTRAL] Yes, one moment and I can provide you that.
[AGENT][NEUTRAL] OK. The group number is going to be 70073.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then and medical um claims go to [PII].
[AGENT][NEUTRAL] That is correct. [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect I think I have everything I need thank you so much. Can I get a call reference number?
[AGENT][NEUTRAL] OK, and then one last thing.
[AGENT][NEUTRAL] Yes, [PII], one thing first, once the claim has been processed through APO, we do have a portal that you should be able to check claim status and have access to the EOBN, and that portal website for us is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And as far as a call reference number you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, what was your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, [PII]. OK, thank you so much.
[AGENT][POSITIVE] You are certainly so welcome and if that's all I can help you with this morning [PII], thank you again for calling APO and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye bye.