AccountId: 011433970860
ContactId: 4c60d2e1-1fa2-42b9-a388-747aae7a69af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423619 ms
Total Talk Time (AGENT): 143782 ms
Total Talk Time (CUSTOMER): 180436 ms
Interruptions: 6
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/4c60d2e1-1fa2-42b9-a388-747aae7a69af_20250515T20:05_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is.
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is calling from. How are you?
[AGENT][POSITIVE] I'm good. I'm so sorry. What is your name again? I'm so sorry.
[CUSTOMER][NEUTRAL] is on different places.
[CUSTOMER][NEUTRAL] You're fine, [PII].
[AGENT][POSITIVE] [PII], thank you so much [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] OK OK let us know and we'll go ahead and check that. Office phone number is [PII].
[AGENT][POSITIVE] Thank you so much and how can I help you please [PII]?
[CUSTOMER][NEUTRAL] OK. So I'm calling for um uh benefits for a patient.
[AGENT][POSITIVE] OK, I can certainly assist you with that. Do you have that policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 02579259.
[AGENT][NEUTRAL] OK, what was the last digit?
[CUSTOMER][NEUTRAL] 9.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh first name, [PII]. Last name [PII] Date of birth [PII].
[AGENT][POSITIVE] Thank you very much and would you need to get this for?
[CUSTOMER][NEUTRAL] Um, I'll take a look at one.
[AGENT][NEUTRAL] Patient or outpatient today for this member?
[CUSTOMER][NEUTRAL] I'm outpatient.
[CUSTOMER][NEUTRAL] He third party or group.
[AGENT][NEUTRAL] OK, and would this be for an office setting or a facility charge?
[CUSTOMER][NEUTRAL] I'm sorry, you cut out.
[AGENT][NEUTRAL] Would this be, I'm so sorry, an office, would this be for an office visit or a facility charge?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] My office is it?
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I do have some CPT codes to provide, um, to ensure that these codes would be covered.
[AGENT][NEUTRAL] Um, there are no pre-certs or pre-authorizations for acquiring this plan because this is secondary, um, in regards to the office visit, it does not cover an office visit.
[CUSTOMER][POSITIVE] Well thank you. Go ahead.
[CUSTOMER][NEUTRAL] Oh, unfortunately does not cover an office visit? OK, um, now do you pick up procedures if a procedure is need is done?
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Um, services or procedures inside the office that could be covered up to the outpatient max.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let me get that for you.
[AGENT][NEUTRAL] Please note verification of benefits provided does not guarantee payment. We pay up to $1500 for the calendar year.
[AGENT][NEUTRAL] Let me just check to see if there's a deductible. Give me one moment.
[CUSTOMER][POSITIVE] OK, repeat that amount. I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's OK. $1500 is the max that we will pay for the year.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. And then I'll go ahead with your next one.
[CUSTOMER][NEUTRAL] The next thing you were saying, I'm sorry.
[AGENT][NEUTRAL] OK, um, we do help with the major medical deductible copay, and our co-insurance. Um, again, we do not, um, there's no resources or pre-op.
[AGENT][NEUTRAL] Stations required on any of our policies.
[CUSTOMER][NEUTRAL] OK. Um, and then, um, does this, uh, policyholder have a group number?
[AGENT][POSITIVE] Of course, give me one moment, get that for you.
[AGENT][NEUTRAL] Group number is 262-01.
[CUSTOMER][NEUTRAL] And is there an effective date for this policy?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK. And then, um,
[CUSTOMER][NEUTRAL] May I have a medical claims address?
[AGENT][NEUTRAL] Certainly. It is APL claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] PO Box 248,950.
[CUSTOMER][NEUTRAL] I should
[CUSTOMER][NEUTRAL] If I should send the prescription.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I can.
[AGENT][NEUTRAL] 73124.
[CUSTOMER][NEUTRAL] OK. I'm gonna repeat that back, OK? So it's APO claims [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We also have a fax number and payer ID if you like that as well.
[CUSTOMER][NEUTRAL] OK. Uh, let me put that in.
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, our fax number is [PII].
[AGENT][NEUTRAL] 3659423.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. And then your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] All right, Ms. [PII]. May I have a reference number for this call?
[AGENT][NEUTRAL] We do not use reference numbers um.
[AGENT][NEUTRAL] Now please use my name and today's date. My last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. That is what I needed. And just to recap, uh, you guys pay, uh, um,
[CUSTOMER][NEUTRAL] Does not cover office visits, but you pay up to 1500 for um procedures done in um
[CUSTOMER][NEUTRAL] Clinics.
[AGENT][NEUTRAL] Do in the office.
[CUSTOMER][NEUTRAL] Within the office, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] That is correct, of course, it has to be due to a sickness or an injury.
[CUSTOMER][NEUTRAL] Sickness or an injury. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right. So I have that information. Thank you for that.
[AGENT][POSITIVE] You're welcome, [PII], and thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you, you as well.
[AGENT][POSITIVE] Thank you bye.