AccountId: 011433970860
ContactId: 43bb7e06-069a-4e2a-9901-0186dcd02856
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311489 ms
Total Talk Time (AGENT): 125501 ms
Total Talk Time (CUSTOMER): 147411 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/43bb7e06-069a-4e2a-9901-0186dcd02856_20250430T18:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] My name is [PII] and I was calling to obtain a verification of benefits for a member.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02595732
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, er, are there any medical benefits?
[AGENT][NEUTRAL] Oh, yes, ma'am. This is a secondary um medical policy. Um, so we applied to the co-pay, deductible and co-insurance after, let me see, United Healthcare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then did you want to go over like outpatient benefits or?
[CUSTOMER][NEUTRAL] So when you said um United Healthcare, you mean after the primary or you have her primary listed as United Healthcare? Because she presented with Blue Cross Blue Shield to us.
[AGENT][NEUTRAL] Let me double check. Hold on one second.
[CUSTOMER][NEUTRAL] she let me see where if she had that, yeah.
[AGENT][NEUTRAL] Yeah, this policy is second only to United Healthcare.
[CUSTOMER][NEUTRAL] OK, OK, so if she needs to update like coordination of benefits, that's something she would have to inform you if her primary change or like this in other words, this is.
[CUSTOMER][NEUTRAL] This secondary is only applicable if the primary is United Healthcare, or it, OK, got you.
[AGENT][NEUTRAL] Right. Now, unless
[AGENT][NEUTRAL] Unless her employer notifies us that because this these policies are through their employer. So if they notify us that they've changed, you know, their medical, their major medical, then we could update that, but as of now, it's still showing as United Healthcare.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK great so I'll just wait and see um what happens. I had to send in um a copy of the primary payment uh with a copy of the explanation of benefits um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To to get the um to get the claim in but it do you show the claims mailing address?
[AGENT][NEUTRAL] Our claims mailing address or United Healthcare?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Your yours.
[AGENT][NEUTRAL] Ours, um, yes ma'am, it's [PII].
[CUSTOMER][NEUTRAL] OK, good, yeah, that's what [PII], mhm.
[AGENT][NEUTRAL] That's the one you sent it to?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so, alright, and so is there um so it's secondary and what, what about um outpatient, uh, physician specialist office?
[AGENT][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] Uh, benefits, mhm.
[AGENT][NEUTRAL] So for outpatients, the policy will pay up to $6900 per calendar year.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] There is a $1000 deductible for sickness only.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, in terms of like the office setting, the policy itself doesn't have any coverage, but um they do have the office treatment rider, so the treatment in the office um could be covered up to that $6900 per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Not a problem. Just the it depends on the, the claim, the information that's on the claim, right?
[CUSTOMER][NEUTRAL] Is as far as if that would apply.
[AGENT][NEUTRAL] Right, so like if you all bill like like a 99213 that will most likely be denied because it's place of service, but if you bill for like, I don't know, some type of treatment she received in the office, then it could pay out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yeah. Mhm. And we do. Yeah, we do because we uh bills like different little surgical codes and stuff too, so all right, my dear, well, this is very um helpful and then as far as that other um situation, I'll just give the claim a little time or reach out to the patient to see if she made a change or if the company made a change, but I'll, I'll wait on that. But thank you for going over with me um and this is the only member I had to check today.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APO [PII]. I hope you have a great evening.
[CUSTOMER][POSITIVE] Yeah you as well thank you again bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.