AccountId: 011433970860
ContactId: 30a99e99-ac22-4a76-8274-cbfe2106ff3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399260 ms
Total Talk Time (AGENT): 201155 ms
Total Talk Time (CUSTOMER): 157174 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/30a99e99-ac22-4a76-8274-cbfe2106ff3c_20250620T12:28_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, good morning. I'm calling on behalf of a patient that's having a procedure in our facility. The patient has, um, this insurance is a secondary. I just wanna make sure that the plan is active and it covers the, uh, primary deductible insurance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so you're needing to get eligibility and benefits for a member, is that correct? Yes ma'am, I can help you with those things, and who am I speaking with please?
[CUSTOMER][POSITIVE] Correct, yes, mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, and [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Yes, it says outpatient benefits certification numbers that's the one doesn't it?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK, 02119982 letter M as in Mary, L as in Lima and the number 8.
[AGENT][NEUTRAL] OK, thank you, [PII]. One moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and [PII], what is, um, well, first off, hold on one second.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And again, any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yes, patient name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he had been the subscriber on the policy that you gave me. Now, the policy number you provided for me, [PII], it's an older policy that's no longer active. He does have an active policy, and I will provide you that information. But this policy
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this one, this policy is not active.
[AGENT][NEUTRAL] This one termed, correct, this one termed [PII].
[AGENT][NEUTRAL] And his current act.
[CUSTOMER][NEUTRAL] OK, so terminated let me let me document that terminated on what's the date?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] But he does have another policy that is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that policy number, [PII] is going to be 02.
[AGENT][NEUTRAL] I'm sorry, 0, OK, let me start again. 025689887.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if you will give me just.
[CUSTOMER][NEUTRAL] 025 I'm sorry 0256.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] The policy, the active policy is 0256898887.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And it's active since [PII] to current, right?
[AGENT][NEUTRAL] That is correct. So give me a moment to get that information pulled up. And you are also needing benefit information, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, for ambulatory surgical center and the patient is having a colonoscopy and endoscopy. I don't know if you need the codes to see if it covers.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. I don't. No, ma'am.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Hi, you're welcome.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $1500.
[AGENT][NEUTRAL] And there is no
[CUSTOMER][NEUTRAL] So the plan covers.
[CUSTOMER][NEUTRAL] 1500.
[AGENT][NEUTRAL] I've covered outpatient services per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now because this is a supplemental plan to his primary insurance, when the claim is submitted to APO for review, we must also receive a copy of his primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim, we have a portal that you should be able to check claim status in by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um and the 1500 is available?
[AGENT][NEUTRAL] As of now.
[AGENT][NEUTRAL] He has not used any of the benefits for this calendar year as of now.
[CUSTOMER][NEUTRAL] where
[CUSTOMER][NEUTRAL] And he's available OK.
[AGENT][NEUTRAL] As of now
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] As to date, OK, perfect. So the plan and it covers anesthesia too?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That benefit amount I gave you is the maximum outpatient per calendar year benefits.
[CUSTOMER][NEUTRAL] Per gallon, OK, but this plan will covers anesthesia as well, right?
[CUSTOMER][NEUTRAL] It's just the
[AGENT][NEUTRAL] It can be reviewed under his outpatient benefit.
[CUSTOMER][NEUTRAL] OK, OK, can I get a reference number for me please?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes ma'am. You would use my name that I gave you [PII] along with today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And your name is?
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] Can you spell it for me please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] and initial last name?
[AGENT][NEUTRAL] [PII] and your initial?
[CUSTOMER][POSITIVE] [PII]. OK, I'll do today's date [PII]. [PII], thank you so much. OK.
[AGENT][POSITIVE] Thank you
[AGENT][POSITIVE] Oh, you're very welcome, [PII], and that's all I can help you with. Thank you for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. So I'm so sorry. Let's verify the policy new active policy because I'm gonna put that in the system. It's 0256898887.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][POSITIVE] OK, thank you so much OK bye bye thanks bye.
[AGENT][POSITIVE] You are so welcome uh huh bye bye.