AccountId: 011433970860
ContactId: 3505ed1e-32c6-4e5f-b6bd-cf08eeea9cec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311320 ms
Total Talk Time (AGENT): 152848 ms
Total Talk Time (CUSTOMER): 74317 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/3505ed1e-32c6-4e5f-b6bd-cf08eeea9cec_20250610T13:26_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] Good morning. My name is [PII] last initial [PII]. I'm calling over from a provider's office. I'm just looking to get some information on this policy.
[AGENT][NEUTRAL] Just
[AGENT][NEUTRAL] OK, [PII], are you needing to verify eligibility and benefits or just eligibility or?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] eligibility benefits of a pre-certs needed, how you guys act as a secondary payer.
[AGENT][POSITIVE] Yes ma'am, I can help you with all of that, [PII], and what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII] and then my extension is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Alright, is that the outpatient benefit cert number?
[AGENT][POSITIVE] Uh, yes, you can give me that. That'll be fine. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so it's 01994046 M like Mary L like Lima 8.
[AGENT][NEUTRAL] OK, thank you. Give me a couple of moments please, [PII] to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that Ms. [PII] is the spouse of the subscriber on this supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, this is a supplemental policy to their primary insurance that helps with co-pays, deductibles and co-insurance amounts of coverage services. So what type of benefit information do you need for her, [PII], inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] So she's having outpatient surgery done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $5000 per covered person, and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And as of now, on this calendar year, she's used $2.34 of that benefit.
[CUSTOMER][NEUTRAL] OK, so her primary has a hefty deductible that they hold them responsible for, so we would just bill you the difference and then you take care of it is that how that works or?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Oh, well, again, I can't guarantee payment. I can only provide the benefit information, so the claim will be filed first with her primary insurance and then with APO because we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then [PII] once we've processed our claim here, we do have a portal that you all should be able to check our claim status in, and the website that you would go to for that is located at [PII].
[CUSTOMER][NEUTRAL] All right and then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and then do you have a reference number?
[AGENT][NEUTRAL] Uh, sure, you're gonna use my name along with today's date.
[AGENT][NEUTRAL] And if you need the first initial [PII] to my last name, it's [PII] and I spell [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Well, you're very welcome. Is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] No that was all thank you.
[AGENT][POSITIVE] OK, [PII]. Well, it was my pleasure in speaking to you today and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.