AccountId: 011433970860
ContactId: 38844401-634d-49bb-9594-2fd800a9f2b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264470 ms
Total Talk Time (AGENT): 140939 ms
Total Talk Time (CUSTOMER): 73837 ms
Interruptions: 5
Overall Sentiment: AGENT=2.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/38844401-634d-49bb-9594-2fd800a9f2b7_20250514T13:22_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I was calling for benefits and eligibility.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits to remember, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is your callback number, please?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] It's 025.
[CUSTOMER][NEUTRAL] 85,130.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] His name is [PII] and his date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you
[AGENT][NEUTRAL] OK, so I do show that Mr. [PII] is the subscriber on the supplemental policy and yes ma'am, it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Office for specialist office visit.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] OK, so on this policy, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This policy, if there was some form of treatment in the office, that is something that could be reviewed on here, but just for an office visit itself, that is not a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then I also
[CUSTOMER][NEUTRAL] I also have some CPT codes that may be performed in the office if you need them, but.
[AGENT][NEUTRAL] No ma'am, we will have to have a re.
[CUSTOMER][NEGATIVE] I really don't think it would do much for him since he was OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Um, so again, his out, if you would like, I can provide you his outpatient benefits information. So if you also submit a claim for any treatment that's rendered for him in the office for review, but he has an outpatient benefit maximum. Let me get back to that, just one moment, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The outpatient benefit max per calendar year for covered outpatient services is $2000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year. Now, if you do submit a claim to us for review, we will have to have a copy of his primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then once we process the claim here [PII], we do have a portal in which you should be able to check our claim status and the website for our portal is located at secured.
[CUSTOMER][NEUTRAL] Hi, good morning, um, doctor.
[CUSTOMER][NEUTRAL] I didn't.
[CUSTOMER][NEUTRAL] What's the person name? [PII].
[CUSTOMER][NEUTRAL] This is. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Awesome. OK. Do you have a reference number for this call?
[AGENT][NEUTRAL] OK, right.
[AGENT][NEUTRAL] Uh, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] 5 14 2025. Awesome OK perfect thank you so much for your time I appreciate it. Hope you have a great day.
[AGENT][POSITIVE] Yes, ma'am. OK, well, you are, oh, I hope you have a great day too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thanks. Bye. Thank you.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.