AccountId: 011433970860
ContactId: 4d51e91b-c8ea-48cf-be88-cb6698d07593
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269570 ms
Total Talk Time (AGENT): 147395 ms
Total Talk Time (CUSTOMER): 90268 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=2.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/4d51e91b-c8ea-48cf-be88-cb6698d07593_20250206T19:31_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], I'm calling from a provider's office in [PII], and we've got one of your patients in our office, and he's coming here for a hearing aid test and I've never heard of this plan before. I don't know if this is.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Like a primary insurance or supplementary if it covers anything so I thought I'd just give a call.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and some benefit information for a member, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And who am I speaking with?
[CUSTOMER][POSITIVE] My name is [PII]. I'm sorry.
[AGENT][POSITIVE] Thank you. And [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02551589
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information day that I do provide for you will be a verification of benefits and not a guarantee of payment. Excuse me, what is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that Mr. [PII] is the subscriber on this supplemental policy and it is active with an effective date of [PII].
[AGENT][NEGATIVE] This is not
[AGENT][NEUTRAL] Major medical insurance fee. It is a supplemental plan. It is supplemental to his primary health care insurance that helps with co-pays, deductibles, and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] So if Blue Cross is primary we would bill them first and then we just bill you after to see if you cover anything or?
[AGENT][NEUTRAL] That is correct because we do have to have a copy of the primary insurance company's explanation of benefits along with the claim for review. Now, office visits are not covered under this policy.
[AGENT][NEUTRAL] However, we can review treatment rendered in the office.
[AGENT][NEUTRAL] Under his outpatient. OK. I'm
[CUSTOMER][NEUTRAL] Yeah, we're not we don't charge them.
[CUSTOMER][NEUTRAL] Yeah, we don't charge him for offices that we just be charging him for a hearing test, an audio test.
[AGENT][NEUTRAL] So we, yes, ma'am. So we can review under his treatment.
[CUSTOMER][NEUTRAL] Do we do that now or do we do that after you guys do that later?
[AGENT][NEUTRAL] Rider. No, ma'am. No, we have to, we cannot review a claim until it's been processed by his primary insurance because we do have to have that EOB showing.
[CUSTOMER][POSITIVE] Got you, got you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That they have paid
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I will make a note of that and this is claims information American Public Life [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Now, his
[AGENT][POSITIVE] Uh-huh. That is correct.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And the last, uh, did you want his outpatient benefit maximum per calendar year or no?
[CUSTOMER][NEUTRAL] No, it's fine. We'll, we'll let you guys figure that out. We just won't charge him anything so we have those. I'm not trying to do more work.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Ah, I hear you now. I did want to give you one more piece of information. We, once we have processed our claim here at APL, we do have a portal that you should be able to check our claim status in and have access to the ELB by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All right, thank you so much for your help today.
[AGENT][NEUTRAL] All right. Well, can I
[AGENT][POSITIVE] Yes, ma'am. You're very welcome. Can I help you with anything else?
[CUSTOMER][POSITIVE] I think we're all good. Have a nice.
[AGENT][POSITIVE] All right, well then, thank you.
[AGENT][POSITIVE] Yes ma'am. Well, thank you for calling APL and I hope you have a nice rest of your day as well.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Yes ma'am, bye bye.
[CUSTOMER][NEUTRAL] Yeah.