AccountId: 011433970860
ContactId: 4b82520c-c489-411e-8331-aff08ee7eeaa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328559 ms
Total Talk Time (AGENT): 149959 ms
Total Talk Time (CUSTOMER): 99774 ms
Interruptions: 3
Overall Sentiment: AGENT=1.6, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/4b82520c-c489-411e-8331-aff08ee7eeaa_20250509T20:30_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling with um Miami Vascular Surgery, and I have a patient who has this insurance as her secondary insurance, and I wanted to know, do you cover the deductible from her primary?
[AGENT][NEUTRAL] OK, so you're wanting to find out, [PII], what type of policy the member has with APL?
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[AGENT][POSITIVE] Yes, ma'am, I can help you. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] 02064066
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, so any information that I provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII] with the date of birth of [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on the supplemental policy, [PII], and it is active, effective [PII].
[AGENT][NEUTRAL] And this policy is a supplement to our primary insurance that's designed to help her with co-pays, deductibles, and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] And then so does she have a deductible on this account, on this plan also, or she, it automatically covers her deductible?
[AGENT][NEUTRAL] No, and again I can't guarantee payment, so what are you needing inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] She had, she was seen inpatient.
[AGENT][NEUTRAL] OK, so on her policy, let me pull that information up.
[CUSTOMER][NEUTRAL] And in case we see her in the office, can you give me both?
[AGENT][NEUTRAL] Sure. One moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so on this policy, her maximum in hospitals benefit is $5000 per covered person per confinement with no deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you were inquiring about an office visit. Is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, so on here she does have a treatment rider in which the benefit amount would be $25 per visit and a maximum of 4 visits per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4 visits per year. You said 4 visits per year per person per covered person.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, per calendar year per cover. Correct, yes ma'am.
[CUSTOMER][POSITIVE] OK, perfect. That's exactly what I needed to know. Thank you so much for your help.
[AGENT][NEUTRAL] Well, you're welcome, [PII]. And if you all end up filing now because it is a supplement to your primary insurance, we will have to have a copy of her.
[AGENT][NEUTRAL] Primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL.
[AGENT][NEUTRAL] We do have a portal that you should be able to check claim status in and that portal website is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the address to mail because I would obviously mail you the claim so that I can mail the remit with it would be um [PII]. 0, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh, I have no idea what that address is.
[AGENT][NEUTRAL] Uh, the claim
[CUSTOMER][NEUTRAL] Oh no, wait a minute, that's you and.
[AGENT][NEUTRAL] I don't know that one.
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, perfect. Perfect, perfect. All right. I will get this together for you. Thank you so, so much.
[AGENT][NEUTRAL] OK, all right.
[AGENT][POSITIVE] OK. Oh, you are certainly very welcome. It was my pleasure. And is there anything else, [PII], that I can help you with today?
[CUSTOMER][POSITIVE] No, no, thank you. Enjoy your weekend.
[AGENT][POSITIVE] I hope you have a wonderful weekend as well and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you. You take care.
[AGENT][POSITIVE] Yes, ma'am, you too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.