AccountId: 011433970860
ContactId: 393918ed-4497-4619-bffe-f899c07a520a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 194679 ms
Total Talk Time (AGENT): 114009 ms
Total Talk Time (CUSTOMER): 54678 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/393918ed-4497-4619-bffe-f899c07a520a_20250103T19:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, um, I need to verify benefits for patient, please.
[AGENT][NEUTRAL] OK, you're needing to verify benefits only or do you also need eligibility?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Eligibility and benefiting.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with these things. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] 02518719.
[AGENT][POSITIVE] Thank you. One moment please.
[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 the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So he is the subscriber rather on the supplemental policy. The supplemental policy is active with an effective date of [PII]. And what type of benefit information [PII], are you needing inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] Out outpatient office uh we're a facility but uh we uh bill as an office only for the MRI it's an MRI.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so now, an office visit, if there's an a visit charge, OK, I was gonna say cause that is.
[CUSTOMER][NEUTRAL] No, no, we don't, we don't collect doctor. No, no, no, it's only the MRI. I'm sorry, but we bill as an Office 11 professional.
[AGENT][NEUTRAL] OK, so the
[AGENT][NEUTRAL] OK, the office, excuse me, the outpatient benefit maximum.
[AGENT][NEUTRAL] Is $300 per covered person per calendar day.
[AGENT][NEUTRAL] For covered outpatient services with no outpatient deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][NEUTRAL] And when the claim is submitted to us and need a full review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then lastly we do have a portal in which you can check claim status and have access to the explanation of benefits with APL and our web portal is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you. Can I have a?
[AGENT][POSITIVE] OK, well, you're welcome.
[AGENT][NEUTRAL] Yes, ma'am. You would use my name along with today's date.
[CUSTOMER][NEUTRAL] Could you spell it for me, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And what's the first letter of your last name?
[AGENT][NEUTRAL] Yes, and yours?
[CUSTOMER][NEUTRAL] Mine is uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you, [PII]. I appreciate your help.
[AGENT][POSITIVE] Absolutely, I mean, it's my pleasure and thank you again for calling APL. I hope you have a nice weekend.
[CUSTOMER][POSITIVE] You too thank