AccountId: 011433970860
ContactId: 2718841c-a8b3-487d-9ddd-39bd4d1a31b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302570 ms
Total Talk Time (AGENT): 172233 ms
Total Talk Time (CUSTOMER): 49740 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/2718841c-a8b3-487d-9ddd-39bd4d1a31b7_20250513T14:28_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], my name is [PII]. I'm calling from ENT and allergy Associates, and I was just calling to verify benefits on a patient please.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify eligibility and benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And how do you spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 01669817 ML 8
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And carry 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 their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. I do show that Ms. [PII] is the subscriber on this limited benefit plan and it is active with an effective date. I'm sorry, I said a limited benefit plan. This is a supplemental plan to her primary insurance and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, it would be office visit and CT scan.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, so on her policy, an office visit is not covered.
[AGENT][NEUTRAL] The CT can be reviewed under her outpatient benefit maximum, and on this policy she has an outpatient benefit maximum per calendar day for covered outpatient services of $500 and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK, so an office visit is not covered.
[AGENT][NEUTRAL] That is correct. The visit itself is not covered.
[CUSTOMER][NEUTRAL] What about a nasal endoscopy? I, I can give you the procedure code.
[AGENT][NEUTRAL] Yes ma'am, a code is not going to help me because we're gonna have to receive the claim along with her primary insurance company's explanation of benefits. Now she does have an office treatment writer on her policy, so we can review treatment within the office, but the, uh, again, an office visit itself is not covered, and an office treatment falls under that same benefit maximum of $500 per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we would need to submit a paper claim, is that correct?
[AGENT][NEUTRAL] We will have to receive the claim along with our primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and what is the address for claims?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and may I have a reference number for our call?
[AGENT][NEUTRAL] Yes ma'am, you would use my name that I gave you along with today's date and one last thing here, if you all end up filing a claim with us for her once we have processed the claim here at APL, we do have a portal in which you should be able to check her claim status and the portal website is located at [PII].
[CUSTOMER][POSITIVE] OK great OK thank you.
[AGENT][POSITIVE] Well, you're certainly very welcome. Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[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.
[AGENT][POSITIVE] Thank you. Bye bye.