AccountId: 011433970860
ContactId: 3977fe60-4cb7-48c9-8c4e-4d3aa53bba15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342940 ms
Total Talk Time (AGENT): 160865 ms
Total Talk Time (CUSTOMER): 68766 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/3977fe60-4cb7-48c9-8c4e-4d3aa53bba15_20250219T13:24_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. I'm calling from my family physicians regarding a patient's benefits.
[AGENT][NEUTRAL] OK. Are you also needing eligibility or do you just need benefit information?
[CUSTOMER][NEUTRAL] Just the benefit information please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] With [PII]
[AGENT][NEUTRAL] Thank you, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Our callback number would be [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Let me see 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And that would be the group number or?
[AGENT][NEUTRAL] No, ma'am. Depending on the type of policy they have as to how it's worded on their ID card. There may be an in-hospital or outpatient number.
[CUSTOMER][NEUTRAL] Uh, yes, I have both. Which one would you like?
[AGENT][NEUTRAL] Do you need outpatient benefits?
[CUSTOMER][NEUTRAL] Uh yes, please, let me see, so it would be 021.
[AGENT][NEUTRAL] Yes, that number.
[CUSTOMER][NEUTRAL] 408.
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] M as in mom, L as in Larry, 8.
[AGENT][NEUTRAL] OK, thank you one moment please, [PII].
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her patient's name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So, I need to get
[AGENT][NEUTRAL] Give you an updated policy number, the policy number that you have number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her current active policy number that you should have is 02502537.
[AGENT][POSITIVE] And this policy is active with an effective date of [PII]. I know you said you did not need eligibility, but since you did not have the correct policy number, so give me just a moment, [PII], to get that information pulled up and I'll be happy to give you benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you get, again, inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Uh, office benefits please.
[AGENT][NEUTRAL] OK, so her outpatient benefit max for calendar year for covered outpatient services is $2500 and there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because this is a supplemental.
[AGENT][NEUTRAL] Policy to her primary insurance, you will also need to submit a copy of her primary insurance company's explanation of benefits with the claim for review.
[AGENT][NEUTRAL] And then [PII], we do have a portal in which once we have processed our claim you should be able to check claim status and have access to our EOB by going to secured.
[CUSTOMER][NEUTRAL] on my desk
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there any other information that I can help you with today?
[CUSTOMER][NEUTRAL] I was wondering if you could provide me with the cost of the benefits. So like I see here before last year, um, the insurance cover $25.06 visits.
[AGENT][NEUTRAL] Just one moment. OK, so it's for an office visit.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Being mind that what hospital gracias.
[AGENT][NEUTRAL] OK. And is this for a specialist or primary care?
[CUSTOMER][NEUTRAL] Primary care.
[AGENT][NEUTRAL] OK. So, yes, on this benefit policy for an office visit, for a physician's office visit.
[AGENT][NEUTRAL] It is, the benefit is up to $25 per visit and a maximum of 4 visits per cover person per calendar year.
[CUSTOMER][POSITIVE] OK alrighty thank you so much, [PII].
[AGENT][POSITIVE] You are certainly very welcome. So again, if that is all I can help you with today, [PII], thank you again for calling APL and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.