AccountId: 011433970860
ContactId: 2c07ca58-0ee7-40e9-a052-75546cb478d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 675799 ms
Total Talk Time (AGENT): 344962 ms
Total Talk Time (CUSTOMER): 226466 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/2c07ca58-0ee7-40e9-a052-75546cb478d9_20250415T17:41_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the office of Doctor [PII]. I have two patients that I need to verify, uh, benefits and eligibility.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and benefits for two separate members, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And could you please give me your first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, OK. I'm sorry, I misheard that. OK, [PII], thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And yes, ma'am, I can help you with um excuse me, eligibility and benefits for the two members. Now then that you will use my name along with today's date as each of your call reference numbers. Again, my name is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then any information that I do provide for you will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And lastly then, um, OK, so I'll just, well, I'm gonna go ahead and give you this information. So if you all end up filing a claim with APL.
[AGENT][NEUTRAL] We do have a portal that you should be able to check claim status in once we have processed claims and our website for the portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] AN
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Again, it's secured secured. [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] All right. And what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] 02479009, M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and any, again, any information that's provided on these policies would be a verification of benefits and not a guarantee of payment. So what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you very much. So, is your date of, OK, so I need to give you a different policy number. That policy number it was kind of like never active. It has this, the effective date and term date are both for [PII]. So let me give you the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just let me know when you're ready.
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] OK, so the correct policy number you should have is 0261.
[AGENT][NEUTRAL] 1879.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[CUSTOMER][POSITIVE] Oh OK perfect.
[AGENT][NEUTRAL] And then what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] The patient is.
[CUSTOMER][NEUTRAL] I'm sorry. No, no, the patient is going to have surgery, office setting, specialist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, just one moment and let me pull some additional information up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum is.
[AGENT][NEUTRAL] $6000 for per calendar year for covered outpatient services and no deductibles.
[CUSTOMER][NEUTRAL] 6000 max calendar year calendar year.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she has used any of the uh 6000.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] I can check that for you for this calendar year. No, ma'am, as of now, no benefits have been used.
[CUSTOMER][NEUTRAL] OK, so she has the full 1000 available.
[AGENT][NEUTRAL] The full 6000 is currently still available at this moment.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and this is for outpatient office setting.
[AGENT][NEUTRAL] It would fall under her outpatient benefit maximum.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And then because this is a supplemental policy signed to her primary insurance, when the claim is submitted to APO for review, we will also have to have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, oh yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No problem. OK, and this is for deductible, co-insurance, and co-pay.
[AGENT][POSITIVE] Correct, for covered services, yes, ma'am, of covered services, that's correct.
[CUSTOMER][NEUTRAL] That's 6000.
[CUSTOMER][NEUTRAL] OK, so deductible coinsurance and copay.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. [PII], your name at the end is [PII]?
[AGENT][NEUTRAL] No, ma'am. It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you guys on Eastern time?
[AGENT][NEUTRAL] No, ma'am, we're Central time, so it's [PII] where I'm located.
[CUSTOMER][NEUTRAL] Central and it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, so this one is ready.
[AGENT][NEUTRAL] OK, so you don't need any more information on this one?
[CUSTOMER][NEUTRAL] Let me know.
[CUSTOMER][NEUTRAL] No, that's it. All I needed to find out because she has a $6000 deductible, so I needed to find out if you guys were gonna cover the uh deductible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, I can't guarantee payment. We would just but that as her benefit maximum on this supplemental policy, so we'll just have to receive the claim and the primary insurance explanation of benefits for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] All right. And what is your next patient's policy number?
[CUSTOMER][NEUTRAL] OK, and let's go to.
[CUSTOMER][NEUTRAL] Sure, that is 01826185, M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on the supplemental policy 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? OK.
[CUSTOMER][NEUTRAL] Same same outpatient yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so again, um, OK, on this policy her outpatient benefit maximum per calendar year for covered outpatient services is $1500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] So you don't cover the deductible, is that what you're saying?
[AGENT][NEUTRAL] Now, ma'am, I'm saying that there is not, some of the supplemental policies also have outpatient deductibles that have to be met. This policy does not, and the outpatient benefit maximum per calendar year for covered outpatient services is $1500.
[AGENT][NEUTRAL] He covered person.
[CUSTOMER][NEUTRAL] OK, this policy has no deductibles for the patient to cover, and the max is 1500 for outpatient services.
[AGENT][NEUTRAL] Right. Just, yes, ma'am. And on the other policy to make sure the outpatient benefit maximum on the prior member's policy was $6000.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] That was her benefit maximum with no deductible.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No deductible, OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes ma'am, neither one of these two policies had an outpatient deductible with APL to be met.
[CUSTOMER][NEUTRAL] OK, perfect. And this policy will cover primary, deductible, co-insurance, and co-pay.
[AGENT][NEUTRAL] Again, I cannot guarantee payments, but that the plan is designed to help them with their co-pays, deductibles and co-insurance amounts of coverage services.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEGATIVE] And as of now, she has not used any of her benefits.
[CUSTOMER][POSITIVE] Oh great, [PII].
[AGENT][NEUTRAL] For this calendar year as of now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. And same with this one we will have to have that primary EOB as well.
[CUSTOMER][POSITIVE] Full benefits.
[CUSTOMER][POSITIVE] Mhm, yeah. OK. Thank you so much for your help.
[AGENT][POSITIVE] You are certainly very welcome. And can I help you with anything else today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well thank you then for calling APL and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Yes sir thank you bye bye.