AccountId: 011433970860
ContactId: 43c27bf4-da79-42c9-b740-e74aced8364d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310329 ms
Total Talk Time (AGENT): 144714 ms
Total Talk Time (CUSTOMER): 105173 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/43c27bf4-da79-42c9-b740-e74aced8364d_20250219T21:43_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. My name is [PII].
[CUSTOMER][NEUTRAL] I'm sorry, what was your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], hey, this is [PII] with Doctor [PII]'s office. I need to verify um some benefits on a patient, please.
[AGENT][POSITIVE] OK, hey, it would be my pleasure to assist you with benefits for your patient. What is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Well, OK, I guess, I guess there's one for inpatient and one for outpatient, right?
[AGENT][NEUTRAL] Yes, ma'am, and either one would be fine. It's the same policy number.
[CUSTOMER][NEUTRAL] OK, so 02354373 ML 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, I'm showing that her policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] This is a secondary policy to her primary insurance.
[AGENT][NEUTRAL] And are you needing specific benefits?
[CUSTOMER][NEUTRAL] Um, I need benefits for like outpatient surgery like an EGD.
[AGENT][NEUTRAL] OK, she does have outpatient coverage. The maximum we can pay per calendar day is $350 and that's what we can pay towards her deductible, co-pay or co-insurance of her major medical, and again that is a per calendar day benefit.
[AGENT][NEUTRAL] That is also a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, so up to $350 per calendar uh day you said right?
[AGENT][POSITIVE] OK. Right. That's right.
[CUSTOMER][NEUTRAL] Almost said year calendar.
[AGENT][NEUTRAL] I heard it coming.
[CUSTOMER][NEUTRAL] Up to $300 per calendar date can be used.
[CUSTOMER][NEUTRAL] Toward
[CUSTOMER][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] Coinsurance and what else?
[AGENT][NEUTRAL] Co-pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then we would, we would file this after her primary, right?
[AGENT][NEUTRAL] That's correct. When you get that EO EOB back from her primary, then you'll submit a claim to APL with the primary EOB attached.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] You said EOB with claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To APL.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And where would we send that to?
[AGENT][NEUTRAL] Claim submission address is [PII].
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] be able to
[AGENT][NEUTRAL] It can also be faxed, yeah, [PII].
[CUSTOMER][NEUTRAL] That's it 7
[CUSTOMER][NEUTRAL] Oh, it, it can be faxed too?
[AGENT][NEUTRAL] It can be faxed directly to our claims department fax number [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get a reference number for a call?
[AGENT][NEUTRAL] Reference number is my name and today's date, and I spell my name [PII]
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] And you said today's date?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And is there a time on that or no?
[AGENT][NEUTRAL] No time.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alrighty thank you so much.
[AGENT][POSITIVE] Well, it's been such a pleasure to assist you with that eligibility and benefit. [PII]. Thank you for calling APL and I hope you have a wonderful evening. Stay warm.
[CUSTOMER][NEUTRAL] You too, uh.
[AGENT][NEUTRAL] I don't know where you are, but it's cold everywhere, I think.
[CUSTOMER][NEUTRAL] Hey, uh, one more question I didn't ask you, is preset required like for any of this like for her secondary? OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] It is not. We do, it's not. We do follow the guidelines of the major medical.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] My pleasure to assist you [PII]. Thank you for calling APL. You have a wonderful evening.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Bye bye.