AccountId: 011433970860
ContactId: 38de813a-416f-49c2-b698-eef3bd780f1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240339 ms
Total Talk Time (AGENT): 116598 ms
Total Talk Time (CUSTOMER): 72819 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/38de813a-416f-49c2-b698-eef3bd780f1d_20250522T17:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII]. I'm calling from our provider's office. I'm calling to check eligibility for a member, please.
[AGENT][NEUTRAL] OK, [PII], you only need eligibility and not benefits. Is that correct?
[CUSTOMER][NEUTRAL] Um, yeah, well, benefits as well, do you guys cover a secondary or not.
[AGENT][POSITIVE] Yes ma'am, I can help you with both. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] For a member.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] 02586617
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Any information [PII] 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 and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on the supplemental policy.
[AGENT][NEUTRAL] And the supplemental policy is active.
[AGENT][NEUTRAL] The effective date is going to be [PII].
[CUSTOMER][NEGATIVE] Ok, this is a slip slop on top.
[AGENT][NEUTRAL] And then mhm supplement and then what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient office, doctor's office.
[AGENT][NEUTRAL] Uh for an office visit?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you guys are secondary, correct?
[AGENT][NEUTRAL] Yes, this is a supplemental policy to his primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let's.
[CUSTOMER][NEUTRAL] Do you yeah.
[AGENT][NEUTRAL] OK, so on this policy, the benefit would be for physicians, outpatient treatment, it's $25 per visit and a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] what is it?
[CUSTOMER][NEUTRAL] The calendar. OK, so basically his primary has a $60 co-payment. You guys will cover instead of him have to pay $60. You guys will cover the, the, like he's supposed to be responsible for $60. You guys will be paying the difference or no?
[AGENT][NEUTRAL] Again, this policy, the, the benefit, if approved.
[AGENT][NEUTRAL] It is up to $25 per visit and a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when the claim is submitted to us for review, [PII], we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][POSITIVE] Correct. Correct.
[AGENT][NEUTRAL] And then you probably already have our portal website that you can use to check claim status, but if you don't, our portal website for that is located at [PII].
[CUSTOMER][POSITIVE] Mhm. OK, perfect.
[AGENT][NEUTRAL] OK. All right. Well, is there anything else that I can help you with? Yes.
[CUSTOMER][POSITIVE] All right. Thank you so much, OK. No, that's it. You have a beautiful day.
[AGENT][POSITIVE] Oh, I hope you do too, [PII] and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, bye-bye.
[AGENT][NEUTRAL] Yes, ma'am, uh huh bye bye.