AccountId: 011433970860
ContactId: 39041925-e21f-4325-91f0-e7a41042d55e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246369 ms
Total Talk Time (AGENT): 126962 ms
Total Talk Time (CUSTOMER): 61330 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/39041925-e21f-4325-91f0-e7a41042d55e_20250205T18:10_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] Hey [PII], this is [PII] with Doctor [PII]'s office. I needed to get benefits, um, and eligibility on a plan, please.
[AGENT][NEUTRAL] OK, [PII], you're needing benefits and eligibility for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Is 01705313.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And 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 and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I do show that she is the spouse of the subscriber on the supplemental policy, and the supplemental policy is active. The effective date on this plan is [PII].
[AGENT][NEUTRAL] Excuse me, and what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Outpatient, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so there is the outpatient benefit max for calendar year for covered outpatient services is $5850 per covered person again for covered outpatient services.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And that is deductible or out of pocket?
[AGENT][NEUTRAL] This policy.
[CUSTOMER][NEUTRAL] Or is that just the amount that's covered?
[AGENT][NEUTRAL] This policy helps with their deductibles, co-pays, and co-insurance amounts of covered services. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when the claim is submitted to APL for review, we must also receive a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we've processed our claim [PII], we do have a portal that you should be able to check our claim status in and that website is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm sorry, can you give me the amount again that was 5800?
[AGENT][NEUTRAL] And $50.
[CUSTOMER][NEUTRAL] OK, that's for coverage services that helps with the policy, OK and um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. It helps with their co-pays, deductibles and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] OK, and there's no pre-cert required on the plan for anything?
[AGENT][NEUTRAL] That is correct, because this is a supplement. With us, there is no prior authorization required.
[CUSTOMER][NEUTRAL] That you're aware of? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and could I get the initial to your last name and a reference number?
[AGENT][NEUTRAL] Yes, ma'am. The first initial, the first initial and my last name is [PII] and my name along with today's date will be your call reference number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much have a good day.
[AGENT][POSITIVE] Well, I hope you have a great day too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Um, bye-bye.