AccountId: 011433970860
ContactId: 4aebddf3-fc5a-4044-b0c4-9a4e040bc518
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304769 ms
Total Talk Time (AGENT): 129601 ms
Total Talk Time (CUSTOMER): 115940 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/4aebddf3-fc5a-4044-b0c4-9a4e040bc518_20250416T15:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, um, I'm calling from a specialist office. I need to know the.
[CUSTOMER][NEUTRAL] If a patient is still active with her APL please.
[AGENT][NEUTRAL] Yeah, I can see that policy is still active. Uh, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII], no, I'm sorry, [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it's uh 01659806.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Laura, and then number 8.
[AGENT][NEUTRAL] OK, I'm sorry, the digit, uh, right before the M, did you say 6?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] OK, and what was the name for the member please?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that [PII]. Uh, so this policy terminated [PII]. If you'll give me one moment though, I'll see if she has one that's active. It might just be a different policy number.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so she does have one that is currently active. Let me know when you're ready and I can give you that updated policy number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that is 02.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So it's 0258.
[AGENT][NEUTRAL] 367 4.
[CUSTOMER][NEUTRAL] OK. Now, I'm gonna ask you, did you receive
[CUSTOMER][NEUTRAL] A claim from uh from us on this station on [PII].
[AGENT][NEUTRAL] OK, was that the date of service or was that the date that the claim was sent?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, no, no, the date of service.
[AGENT][NEUTRAL] OK, give me just a moment. Let me see if she had a policy when which policy was active. There we go, yes, that was the first one. OK, give me just a moment.
[AGENT][NEUTRAL] What was the uh billed amount for this claim?
[CUSTOMER][NEUTRAL] Well, $50.
[AGENT][NEUTRAL] 50, OK, alrighty, one moment.
[AGENT][NEUTRAL] I do not we have not received a claim for that date of service for this member.
[CUSTOMER][NEUTRAL] OK, and is, is there, uh, uh, is there a, um, a time, an expiration day where we cannot send it any anymore?
[AGENT][NEGATIVE] No, no, there is no timely filing limit.
[CUSTOMER][NEUTRAL] OK, great. Alright, and, and um, I'm sorry for the present coverage, she, uh, he had, she has a copay from her primary insurance if cover copay for outpatient visit for.
[AGENT][NEUTRAL] Um, that is, in short, what this plan is designed for, um, is to help as it's secondary medical, it is designed to help with co-pay, deductible and co-insurance. Um, give me just a moment. You did say this was for a specialist office visit, correct?
[CUSTOMER][NEUTRAL] For office visit.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims, uh, so office visits as well as treatment received in office is covered under their outpatient benefits, um, so that amount is $2500 max per calendar year and again that goes towards co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Very well. OK, great, thank you so much then.
[AGENT][NEUTRAL] Of course. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] I know, so I'm sorry, the last question, if we were to, OK, to send the previous one that apparently for some reason it was never sent, is with the prior number ID number that I gave you, right?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, the 016598006 as that was the policy that was active during that uh date of service.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] All right, thank you so much, thank you.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APO. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK, you too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.