AccountId: 011433970860
ContactId: 31c3fd9d-1f7d-47c4-84b6-f496e8ebd53f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 442869 ms
Total Talk Time (AGENT): 166753 ms
Total Talk Time (CUSTOMER): 122573 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/31c3fd9d-1f7d-47c4-84b6-f496e8ebd53f_20250310T16:37_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, [PII]. Good morning. My name is [PII]. I'm calling from the provider's office. This call is being recorded for quality and training purpose, and I would like to know the information regarding the benefits for one of our patients. Can you please check it with that?
[AGENT][NEUTRAL] OK, you're needing benefit information for a number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that and I'm so sorry, but could you give me your name again? I was not I did not understand what you said initially.
[CUSTOMER][NEUTRAL] My name is [PII] Last name [PII]. May I know your name, please?
[AGENT][NEUTRAL] [PII], and my first initial is also [PII] And I mean, what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. So yes, I mean, I can help you with benefit information. What is your patient's policy number, please?
[CUSTOMER][NEUTRAL] Name of the um.
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] Sorry, member ID is 01660259 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] as
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] And any information I need that I 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] Yeah, the name of the patient is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] So I do show that he is a subscriber on this, I'm sorry, the spouse of the subscriber on the supplemental policy, I may, and the supplemental policy is active with an effective date of [PII]. And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thanks for staying on the line, [PII]. What is the plan type?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This is a supplemental policy to their primary healthcare insurance.
[AGENT][NEUTRAL] The name of the plan is, yes, it's a supplemental policy, not the major medical insurance.
[CUSTOMER][NEUTRAL] Supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient office setting. And you said that plan type is supplemental plan, is it right?
[AGENT][POSITIVE] That is right.
[AGENT][NEUTRAL] And on the supplemental policy office.
[CUSTOMER][NEUTRAL] OK. What's the date?
[AGENT][NEUTRAL] Do you need for me to repeat that again?
[CUSTOMER][NEUTRAL] Yeah, what is the plan type, uh, I'm sorry, what is the effective date?
[AGENT][NEUTRAL] Yes, I've already given you that. Do you need for me to give that to you again?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. For on the calendar year or plan here.
[AGENT][NEUTRAL] This is a calendar year?
[CUSTOMER][NEUTRAL] OK. And I think
[CUSTOMER][NEGATIVE] Occupation the services are not good, I think, is it right?
[AGENT][NEUTRAL] I can check that.
[CUSTOMER][NEUTRAL] It follows the primary insurance guideline. OK.
[AGENT][POSITIVE] That is correct. It does.
[AGENT][NEUTRAL] And office visits?
[CUSTOMER][NEUTRAL] I think they follows
[AGENT][NEUTRAL] I'm sorry, go ahead with all of your questions instead of me having to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think it follows the United Healthcare guidelines.
[AGENT][NEUTRAL] This has its own, but.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, if it's not covered by the primary insurance, it also would not be covered under this policy, and office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] OK. One moment.
[CUSTOMER][NEUTRAL] So, they did not they follow your United Healthcare guidelines, so.
[CUSTOMER][NEUTRAL] The member policy is not covered for the outpatient office setting benefits. Is it right?
[CUSTOMER][NEUTRAL] Anyway
[AGENT][NEUTRAL] The policy does not cover office visits. It does have benefits for therapy done in the office, however, occupational therapy is not covered.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, no issue. Can you please forward me the call reference number for the given information?
[AGENT][NEUTRAL] Yes, my name along with today's date.
[AGENT][NEUTRAL] And is there anything else that I can help you with today, MJ?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Nothing else apart from this. And the original effective date is [PII], is it right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you first and have a nice day.
[AGENT][NEUTRAL] And if you all do
[AGENT][NEUTRAL] Yes sir, and if you do submit a claim to APO for review, you must also include the copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And then also we do have a portal but once we have processed the claim, you can check claim status and have access to our explanation of benefits by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And again, if that is all I can help you with today, [PII], thank you again for calling APL and I hope you have a nice day.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.