AccountId: 011433970860
ContactId: 217c8d8e-f57d-4b50-a284-4e65fc78007a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299959 ms
Total Talk Time (AGENT): 160190 ms
Total Talk Time (CUSTOMER): 75295 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/217c8d8e-f57d-4b50-a284-4e65fc78007a_20250514T17:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm trying to verify a patient's eligibility.
[AGENT][NEUTRAL] Yeah, I can check eligibility for you. um, what was your name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, can I, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02584623.
[AGENT][NEUTRAL] Alright, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. So this policy is active. Effective date was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you know if it covers the outpatient surgery?
[AGENT][NEUTRAL] Um, I could definitely get this policy pulled up and take a look. Um, I will tell you this is a limited indemnity medical plan. So it's different than traditional major medical, just pays a set dollar amount per covered procedure or office visit. So bear with me just a moment, let me get those benefits pulled up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Of course, I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so they do have a surgical and anesthesia benefit under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that surgical benefit amount, the, yeah, so it's a bit confusing. Um, so it, the base amount is for the surgery is $2000. And then for the different kinds of surgery, it pays a percentage based off of that $2000. Uh, the anesthesia benefit would be 25% of the amount we would pay for the surgery. Does that make sense?
[CUSTOMER][NEUTRAL] Do you know what that is? OK.
[CUSTOMER][NEUTRAL] Uh, would it pay for the facility?
[AGENT][NEUTRAL] No, so it's not a facility. It's, it's just the surgical uh benefit itself. It doesn't have a facility benefit.
[CUSTOMER][NEUTRAL] OK, so it doesn't cover facility services?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Like if we're the facility it wouldn't pay us?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Is that where the surgery is taking place?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, so if y'all were the ones to file the claim, then that would go that, uh, payment information would go to you, is that what you mean?
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, yeah, sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You're OK.
[CUSTOMER][NEUTRAL] Alright, and um so it'll pay what up to 2000 and then so she's having like a.
[CUSTOMER][NEUTRAL] Um, gallbladder surgery.
[AGENT][NEUTRAL] It would be a percentage of that 2000, yes.
[CUSTOMER][NEUTRAL] It would pay a percentage of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. And what was your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] And did you have a reference number?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Did you have any other questions for me?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah, I did, um, where would we send the claims to?
[AGENT][NEUTRAL] Sure, um, let me know when you're ready. I do have um a mailing address, fax number and a payer ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Did you want all of that information?
[CUSTOMER][NEUTRAL] Uh, just where to submit the claims.
[AGENT][NEUTRAL] Yeah, um, OK, so yeah, I've got the mailing address is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then um I've got that fax number and the payer ID whenever you're ready.
[CUSTOMER][POSITIVE] Perfect, I'm ready.
[AGENT][NEUTRAL] OK, so that fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Alrighty and then that payer ID is 60801.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Mm bye.
[AGENT][POSITIVE] Thank you. Bye-bye.