AccountId: 011433970860
ContactId: 26938ae0-e7be-43ef-95e6-52fd259acd91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296850 ms
Total Talk Time (AGENT): 146240 ms
Total Talk Time (CUSTOMER): 45675 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/26938ae0-e7be-43ef-95e6-52fd259acd91_20250227T13:39_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] Good morning, [PII]. My name is [PII]. I'm calling regarding benefits for a patient.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, I'm so sorry that I misunderstood that, [PII]. Thank you. What is your what is your callback number, please?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and you're needing eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am, I can help you with those things. And what is the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 06, sorry, 01611530.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, please, [PII].
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK and [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that Mr. [PII] is the subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient specialist office visit?
[AGENT][NEUTRAL] For an office visit, OK. On this
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me one second to look at one thing first.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so on this supplemental policy, Dina, office visits are not covered. There is an office treatment writer if he were to receive some type of treatment in the office, that could be reviewed under his outpatient benefit maximum, which is $1500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For covered person for covered outpatient services with no deductible, but again, the office visit itself is not covered.
[CUSTOMER][NEUTRAL] OK. Uh, is there a limit for the number of visits or number of procedures done?
[AGENT][NEUTRAL] On this
[AGENT][NEUTRAL] On this policy, as I just stated, it is a $1 amount per calendar year. The maximum benefit is $1500.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, got it. Thank you, [PII].
[AGENT][NEUTRAL] Yes, ma'am, and if you all end up uh filing a claim with APL Vina, you will also need to send us the primary insurance company's explanation of benefits with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we've processed our claim, we do have a portal that you should be able to check our claim status in and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] Well, you're very welcome. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Nothing else right now.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.