AccountId: 011433970860
ContactId: 2c3690d4-d6e7-4bb8-a7ed-6f144d544871
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294690 ms
Total Talk Time (AGENT): 133887 ms
Total Talk Time (CUSTOMER): 63663 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/2c3690d4-d6e7-4bb8-a7ed-6f144d544871_20250609T17:32_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from a provider's office to double check if a patient's plan is still active.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], you're just needing to verify eligibility, is that correct?
[CUSTOMER][POSITIVE] And benefits, yes, ma'am. Mhm.
[AGENT][NEUTRAL] You need eligibility and benefits.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] 02549497
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And I have any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do show that she is a subscriber on the supplemental policy and it is active [PII] 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 for like a specialist office visit.
[AGENT][NEUTRAL] OK, so on the supplemental policy, office visits are not covered.
[AGENT][NEUTRAL] If she were to receive some form of treatment in the office, we could review that under the outpatient benefit maximum, but an office visit itself is not covered.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK. Could I get the details for the outpatient benefits?
[AGENT][NEUTRAL] Uh-huh, sure.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $6000 with no outpatient deductibles.
[AGENT][NEUTRAL] Now if you all end up submitting a claim to us for you [PII] because it is a supplemental plan to the primary insurance, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once the claim has been processed by APO we have a portal that you should be able to check claim status in.
[AGENT][POSITIVE] And that website for our portal is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And I was curious, um, because I know that her primary is Medicare. Do you guys follow the Medicare guidelines also?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] Um, no, this would not be a supplement to Medicare.
[AGENT][NEUTRAL] Her primary insurance according to her employer.
[AGENT][NEUTRAL] Uh, we show is United Healthcare.
[CUSTOMER][POSITIVE] Oh, you're absolutely right. That was, that was a mistake, yes ma'am.
[AGENT][NEUTRAL] Uh, that's OK.
[CUSTOMER][NEUTRAL] Secondary OK.
[CUSTOMER][POSITIVE] Great, uh, that answers my questions. If I could get a reference number, I should be all set.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, you will actually use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Just to make sure I have it right, can I have the spelling of your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Thank you very much, [PII], for your help and you have a great rest of your day.
[AGENT][POSITIVE] All right. Well, you're, uh, [PII], well, I hope you have a nice afternoon too. And if again, if that's all I can help you with, thank you very much for calling APO.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Uh, you're welcome. Bye-bye.