AccountId: 011433970860
ContactId: 3a04ef39-7540-47e1-b165-a627b90af233
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232570 ms
Total Talk Time (AGENT): 106351 ms
Total Talk Time (CUSTOMER): 49773 ms
Interruptions: 0
Overall Sentiment: AGENT=3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/3a04ef39-7540-47e1-b165-a627b90af233_20250226T14:24_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, this is [PII] from the provider office. I need assistance regarding the patient plan eligibility.
[AGENT][NEUTRAL] OK, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Yeah, yeah, spelled as [PII]
[AGENT][POSITIVE] [PII], is that correct? OK. [PII], and you're needing eligibility and benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 50207
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And I, any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] First name, [PII], last name [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. So I do show that she is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Give me a moment. Yes, this is for office medical.
[AGENT][NEUTRAL] OK, so on the supplemental policy, office visits and office treatment is not covered.
[CUSTOMER][NEUTRAL] OK. And but for the hospital inpatient?
[AGENT][NEUTRAL] There is an
[AGENT][NEUTRAL] Patient combined calendar your maximum benefit of $3500 with no outpatient deductible.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] And if you all will be submitting.
[CUSTOMER][NEUTRAL] So, I have
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] If you will be filing a claim with the, with APO for this member, then we will also have to have a copy of her primary insurance company's explanation of benefits as well for review.
[AGENT][NEUTRAL] And then once we have reviewed and processed our claim, we do have a portal yeah yeah where you can excuse me, you can check our claim status and have access to our EOB by going to [PII].
[CUSTOMER][POSITIVE] Sure, got you.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] That's it. Uh, if you have the call reference number for me.
[AGENT][NEUTRAL] Yes, sir, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You are very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Uh, you too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.