AccountId: 011433970860
ContactId: 317cbad5-b0a4-4365-ac22-b4905d6ecbef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303399 ms
Total Talk Time (AGENT): 123137 ms
Total Talk Time (CUSTOMER): 119539 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/317cbad5-b0a4-4365-ac22-b4905d6ecbef_20250303T18:57_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] Yeah, hi, [PII]. My name is [PII] and I'm calling you from the provider office.
[AGENT][NEUTRAL] I'm so sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII]. Uh, it is [PII].
[AGENT][NEUTRAL] [PII], OK, and how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Actually, I'm looking for the claim status. uh sorry, uh, the patient eligibility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you're needing eligibility for one patient. Is that correct, ma'am?
[CUSTOMER][POSITIVE] Yes, yes, right.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 02541646.
[AGENT][NEUTRAL] OK, thank you. Give me one moment, ma'am, to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 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]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I do show she is the subscriber on the supplemental policy.
[AGENT][NEUTRAL] And the supplemental policy is active, Pam, with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK. Could you please uh tell me that uh for this patient, who is the primary insurance?
[AGENT][NEUTRAL] She, uh, oh, you're needing to know. I can only, you would have to verify that with her. For our records, we show that the primary insurance company is, actually, I don't have one listed.
[CUSTOMER][NEUTRAL] OK, that was not listed on your, uh, and like, uh, that, uh, OK, this.
[AGENT][NEUTRAL] No, ma'am, it is not. Yes, ma'am, it's not listed.
[CUSTOMER][NEUTRAL] OK, so there is no updated the primary insurance name, right? So you are the secondary insurance for this patient, right?
[AGENT][NEUTRAL] That is correct. We are not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK. And could you please tell me that um
[CUSTOMER][NEUTRAL] Um, like,
[CUSTOMER][NEUTRAL] If I um know that like uh the when the last COP was updated.
[AGENT][NEUTRAL] Again, we are not a major medical insurance carrier.
[AGENT][NEGATIVE] That there would not be a coordination of benefits with us.
[CUSTOMER][NEUTRAL] So, uh what is this like uh uh this insurance is covered that?
[AGENT][NEUTRAL] This is a supplement yes and this is a supplemental policy only.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So there is not updated anything like the COP and as well the primary insurance information, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the reference number and your name?
[AGENT][NEUTRAL] Again my name is [PII] and my name along with today's date will be your call reference number and if you all do file a claim with APLA, we will have to have a copy of the primary insurance company's explanation of benefits as well along with the claim and then once we have processed our claim, we do have a portal that you can check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK. Could you please tell, well, wait for a second, just a sec.
[AGENT][NEUTRAL] And can I
[AGENT][NEUTRAL] Help you with anything else today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, just a second.
[CUSTOMER][NEUTRAL] OK, could you please uh tell me that your um uh last name initial.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the first name is [PII], right?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII] And [PII], could you please uh uh could you please tell me one thing that uh the, I just uh forget to ask like I just, I don't get it properly, that question, like, like the, uh like, uh, this plan is, uh, this insurance is a patient secondary insurance, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you so much you have a great day bye bye.
[AGENT][POSITIVE] I hope you have a great day too, and thank you again for calling APL if that's all I can help.