AccountId: 011433970860
ContactId: 446faddb-739e-471f-a770-3f8b5ecc8f34
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355739 ms
Total Talk Time (AGENT): 161417 ms
Total Talk Time (CUSTOMER): 139165 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/446faddb-739e-471f-a770-3f8b5ecc8f34_20250207T15:04_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 [PII], um, I wanna see if you can maybe help me so I have a patient and um coming in we are an ambulatory outpatient facility.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I'm trying to figure out what this patient has as a secondary because I've never heard of this insurance.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and outpatient benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII] that's gonna be a direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Policy number I have is 02503207.
[AGENT][NEUTRAL] OK, thank you. So one moment, please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, so any information that I do provide for you, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have [PII] um [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I do show that she is the spouse of the subscriber on the supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the supplemental policy is active, effective [PII].
[AGENT][NEUTRAL] And this policy is again a supplement to the primary insurance and it's designed to help with co-pays, deductibles, and co-insurance amounts of covered services. So the outpatient benefit max per calendar year for covered outpatient services is 1000.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] $500.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] OK, so that means that, OK, so the proc OK, so the procedure that they're having is.
[CUSTOMER][NEUTRAL] They're actually coming in for a double, which is a colonoscopy, but we're gonna let that run by the insurance, but the EGD, which is an upper GI, that that one is for 11:37 so then this secondary insurance will pick that up.
[AGENT][NEUTRAL] Again, I can't guarantee payment um for you, [PII]. We would have to receive the claim for review, but he does have, or she does have an outpatient benefit max of $1500 per calendar year for covered outpatient services. And because this is a supplemental policy, we will have to have a copy of the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Company's explanation of benefits as well for review.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And then once we have reviewed our claim and it's been processed, we do have a portal in which you should be able to check claim status and have access to our explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And our portal website, crystal is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, OK, so then we're just not so then we're just gonna let this process.
[CUSTOMER][NEUTRAL] And then we'll just um yeah OK.
[AGENT][NEUTRAL] And let's see, just one moment, as of now she has not used any benefits for this calendar year.
[CUSTOMER][POSITIVE] OK, OK, perfect then, OK, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] OK, got effective date. OK, then just the, uh, the one, the 1500 outpatient max. OK, alright, Ms. [PII], um, is your name with a Y or an IE?
[AGENT][NEUTRAL] Mhm. Yes ma'am.
[AGENT][NEUTRAL] Neither, just an I.
[CUSTOMER][POSITIVE] Oh perfect OK sorry.
[AGENT][NEUTRAL] And my name and today, that's OK. My name and today's date will also be your call reference number, [PII].
[CUSTOMER][POSITIVE] Perfect all right ma'am, thank you very much I appreciate it.
[AGENT][POSITIVE] I see. You are, you're certainly welcome. And is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] You know what I wanted to ask what I wanna make sure I have the right PO box. What is your PO box, ma'am?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] You can go, uh go ahead and give me what you have and I'll be happy to verify that for you.
[CUSTOMER][NEUTRAL] Yes ma'am, give me one second. I switch patients really quick. OK, so I have, I have PO Box [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Perfect, OK.
[AGENT][NEUTRAL] OK. Well, again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No ma'am thank you very much I appreciate it.
[AGENT][POSITIVE] Well, you're very welcome. And again, thank you for calling APL. I hope you have a, a very nice weekend.
[CUSTOMER][POSITIVE] You too ma'am thank you.
[AGENT][POSITIVE] Thank you. Uh, you're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.