AccountId: 011433970860
ContactId: 3712a3b5-669b-411f-b8a3-2ac7f13007b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 459779 ms
Total Talk Time (AGENT): 212674 ms
Total Talk Time (CUSTOMER): 110057 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/3712a3b5-669b-411f-b8a3-2ac7f13007b1_20250326T12:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Uh yes, ma'am. I have got a patient coming in today that I'm trying to get benefits.
[AGENT][NEUTRAL] OK, you're needing to get eligibility and benefits or only benefit information?
[CUSTOMER][NEUTRAL] Uh, eligibility and benefits.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Uh, this is [PII]
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Uh yes, ma'am. That is 126.
[CUSTOMER][NEUTRAL] 6383.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's informa.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Patient pulled up.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, and you the 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 their date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and it's for [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy, [PII], and this policy is active with an effective date of [PII], I'm sorry, let's try that again. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. And again, this woman.
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK. I'll start.
[AGENT][NEUTRAL] 17.
[CUSTOMER][POSITIVE] I'm sorry, darling. You said that [PII]. Thank you.
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][POSITIVE] Uh, thank you very much, darling.
[AGENT][NEUTRAL] OK, you're welcome. And so are you needing inpatient, outpatient or office benefits for him?
[CUSTOMER][POSITIVE] Of Of benefits for mental health.
[AGENT][NEUTRAL] OK, just one moment please.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's just some of my information can so please bear with me just a moment if you don't mind.
[CUSTOMER][POSITIVE] Oh, you are, you are fine, darling. You take your time.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so on this.
[AGENT][NEUTRAL] Supplemental policy, the benefit for an office visit would be $25 per visit and a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh, do you have how many he's had so far?
[AGENT][NEUTRAL] I can certainly check that. One moment.
[CUSTOMER][POSITIVE] Thank you, honey.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] As of now, I do not show that he has used any for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if you all do end up filing a, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] All right, and.
[CUSTOMER][NEUTRAL] No, you're fine, go ahead.
[AGENT][NEUTRAL] I was gonna say if you all file a claim with APL for him now we will also have to have a copy of his primary insurance company's explanation of benefits as well for review and then once we have processed our claim, [PII], we do have a portal in which you should be able to check claim status and our portal website is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right. I sure appreciate that.
[CUSTOMER][NEUTRAL] And um let me uh I was gonna ask you a question, so that $40 that's for his primary, he would only have to pay the $25.
[AGENT][NEUTRAL] Not 2.
[AGENT][NEUTRAL] No, this, that is the benefit that this plan would pay for a covered, if it is covered.
[CUSTOMER][NEUTRAL] Oh, OK then. OK, so he have to pay, OK, so he had to pay the $40.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then y'all would reimburse. Well, I still, I guess I still, I'm trying to figure out if I need to do the, I'm trying to figure out if I just charge you 25.
[CUSTOMER][NEUTRAL] Or charging 40 for regular copay.
[CUSTOMER][NEUTRAL] I don't know quite how it works together.
[AGENT][NEUTRAL] OK, so this plan is designed to help him with his co-pays, deductibles, and co-insurance amounts of coverage services.
[AGENT][NEUTRAL] And the benefit for an offices.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That or treatment in an office visit.
[AGENT][NEUTRAL] On the mental policy, the max benefit is, or, or the, excuse me, the benefit on this plan would be $25 per visit. That's the benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And a maximum of 4 visits per cover person per calendar year.
[CUSTOMER][POSITIVE] OK, I got you.
[CUSTOMER][NEUTRAL] OK, I got you. I see now. I just had it backwards. Oh I do I should appreciate and do you by chance have a good reference number for me?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and if you need the first initial [PII] and my last name it is [PII].
[CUSTOMER][POSITIVE] Thank you so much, Ms. [PII] for all your help and explaining to a dumb, dumb person about this.
[AGENT][NEUTRAL] Well, he
[AGENT][NEGATIVE] You are not dumb, dumb, dumb at all. I work in it every day and it can be very confusing for me as well, so absolutely not.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Oh, thank you so much, honey. Y'all have a great day.
[AGENT][POSITIVE] Well, oh, yes, ma'am, you too. If that is all I can help you with today, Miss [PII]. I hope you have a wonderful day as well and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you, honey. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.