AccountId: 011433970860
ContactId: 40c15006-7049-449a-a1d5-f226435f55a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 307660 ms
Total Talk Time (AGENT): 139454 ms
Total Talk Time (CUSTOMER): 87194 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/40c15006-7049-449a-a1d5-f226435f55a7_20250617T20:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office, and I'm here to check members eligibility and benefits.
[AGENT][NEUTRAL] OK, [PII], you have one member to check eligibility and benefits for, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII]. You'll need to give me that num, right, but that's, that's, you'll need to repeat that number again from the beginning, please.
[CUSTOMER][NEUTRAL] It is directly.
[CUSTOMER][NEUTRAL] OK, sorry. [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. It is a direct line?
[AGENT][NEUTRAL] OK, [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, yes, that's exactly right.
[AGENT][NEUTRAL] Thank you, and the patient's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah, it is
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 97
[CUSTOMER][NEUTRAL] 159
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] And all the information that I provide for you today will be a verification of benefits and not a guarantee of payment. What again is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Your patient's name is [PII] and date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so, and again, any information provided will be a verification of benefits and not a guarantee of payment. So I do show she is a dependent on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need um today Paul inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Yeah, it is for mental health office visit. It is outpatient.
[AGENT][NEUTRAL] OK. Office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] It is, it is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, can you please repeat it?
[AGENT][NEUTRAL] Office visits are not covered under the supplemental policy.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, then we cannot bill, right? Bill for office visit?
[AGENT][NEUTRAL] I'm just, I didn't tell you how to bill. I'm not telling you how to bill. I'm telling you that under this supplemental policy.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Office visits are not a covered benefit. That is correct.
[CUSTOMER][NEGATIVE] Office is not covered.
[CUSTOMER][NEUTRAL] OK. OK. Is this the right, right?
[AGENT][NEUTRAL] And if you end up
[CUSTOMER][NEUTRAL] Is this the right member ID for this number?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] What I told you.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] She's, she's spouse, right?
[AGENT][NEUTRAL] And there's
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] She's dependent, right?
[AGENT][NEUTRAL] She's a child, a dependent child on this policy.
[CUSTOMER][NEUTRAL] OK, OK. Uh, can I get the timely filing limit date?
[AGENT][NEUTRAL] There's no timely filing limit, and if you all do file a claim with us, you will also need to send the primary insurance company's explanation of benefits with the claim.
[CUSTOMER][NEUTRAL] OK. There is no TFL, right? timely filing limit.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Pay ID please.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Just a 2nd. 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, your name, please?
[AGENT][NEUTRAL] Again, my name is [PII], and my name in today's date will be your call reference number. And also [PII], if you will file a claim with us, you should be able to check the claim status by going to our portal website which is located at [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][POSITIVE] OK, thank you. Have a good day. Bye-bye.
[AGENT][POSITIVE] All right, well, you're, yes, sir, you too, if that's all I can help you with. Thank you again for calling [PII] on APO [PII] and rather, and I hope you have a great day yourself.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh.