AccountId: 011433970860
ContactId: 35467651-217a-47bb-816a-cbe1f3b0cd63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375890 ms
Total Talk Time (AGENT): 177330 ms
Total Talk Time (CUSTOMER): 98835 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/35467651-217a-47bb-816a-cbe1f3b0cd63_20250421T12:17_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] Hey [PII], I'm [PII]. I'm calling for benefits for a number.
[AGENT][NEUTRAL] OK, [PII], are you needing just benefits or do you also need eligibility as well?
[CUSTOMER][NEUTRAL] Yeah, I mean both.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with those things. And [PII], what is a good back number for you?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] 02608297
[AGENT][NEUTRAL] Did you say 297?
[CUSTOMER][NEUTRAL] 297, yes.
[AGENT][NEUTRAL] OK, thank you. One moment, [PII], while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and [PII], 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 please and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that she is the subscriber on this supplemental policy and the supplemental policy is at.
[AGENT][NEUTRAL] [PII] with an effective date of [PII]. And what type of benefits do you need for her inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, it's outpatient for diagnostic laboratory.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is a supplement plan?
[AGENT][NEUTRAL] That is correct. This is a supplement to her primary insurance.
[CUSTOMER][NEUTRAL] Oh, OK, because our primary is United Healthcare. I thought supplements only, uh, go towards Medicare.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no, ma'am.
[AGENT][NEUTRAL] This is a supplemental policy that helps with our co-pays, deductibles, and co-pays.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, for covered services. So on this supplemental policy, she
[AGENT][NEUTRAL] As an $8150 maximum for covered outpatient services, and there is no outpatient deductible per calendar year per covered person.
[AGENT][NEUTRAL] Because this is a supplemental.
[CUSTOMER][NEUTRAL] OK, you say.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Your, your phone cut out. I didn't hear like the first beginning of what you said, so her primary won't cover the services, so you guys will still cover it?
[AGENT][NEUTRAL] OK, if the primary insurance does not cover it, the supplement, there would be no benefits on the supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, not
[CUSTOMER][NEUTRAL] No no.
[AGENT][NEUTRAL] Mhm. Now, should something change and the primary ends up covering the services when the claim is submitted to APL for review, then we would also have to have a copy of her primary insurance company so that we could see.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] We'll co-pay or co-insurance amounts.
[AGENT][NEUTRAL] And then we also have a portal, Brittany that once we've processed the claim we have our portal you should be able to check claim status and the website for that is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And just what are the general benefits? I know you were giving to me before, but the phone cut out. You said she doesn't have deductible or co-insurance?
[AGENT][NEUTRAL] This policy helps her with her co-pays, deductibles, and co-insurance amounts of coverage services. So for covered services, the outpatient benefit maximum is $8150.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He calendar year with no deductible on the supplemental policy.
[CUSTOMER][NEUTRAL] OK, so the secondary assist with co-pay.
[AGENT][NEUTRAL] Deductibles and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] That one call amount.
[CUSTOMER][POSITIVE] For covered services. OK, perfect.
[AGENT][NEUTRAL] Yes ma'am, uh-huh, yes ma'am.
[CUSTOMER][NEUTRAL] OK, so I will let her know.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Because you said that her primary is not covering it. Is that correct?
[CUSTOMER][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] Right, we're out of network and she has an HMO policy for her primary and um, you know.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I got you, OK.
[CUSTOMER][NEUTRAL] So they're not gonna cover that either, um, and [PII], if you don't mind, can I have a call reference?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, you would actually just use my name along with today's date.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] All right. Well, is there
[CUSTOMER][POSITIVE] Well thank you so much I really appreciate you.
[AGENT][POSITIVE] Yes, ma'am. You're certainly very welcome, [PII]. Is there anything else I can help you with this morning?
[CUSTOMER][POSITIVE] Oh, no, that's about it. I appreciate it too again.
[AGENT][POSITIVE] OK. Well then, thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too, bye.