AccountId: 011433970860
ContactId: 4f042593-43ae-4ff1-a279-634be9550741
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320359 ms
Total Talk Time (AGENT): 170078 ms
Total Talk Time (CUSTOMER): 79484 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/4f042593-43ae-4ff1-a279-634be9550741_20250407T12:57_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. Uh, my name is [PII]. I'm calling from a behavioral health office, and I'm calling because we have a client who provided um the insurance with you guys, uh, American Public Life. And I was calling to see if you guys will pick up any primary balance that the client provide the insurance is secondary.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], so you're needing to verify eligibility and benefit information. Is that correct?
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][POSITIVE] Yes, ma'am, I can help you with those things. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02331422
[AGENT][NEUTRAL] OK, thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then and the information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, [PII], um [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so she is the subscriber [PII] on this policy and again any information provided will be a verification of benefits and not a guarantee of payment. So the policy again, it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, office.
[AGENT][NEUTRAL] OK, so on the supplemental policy, office visits are not covered.
[AGENT][NEUTRAL] However, if she were to receive some type of treatment in the office, that could be reviewed under her outpatient benefits, and her outpatient benefit maximum per calendar year for covered outpatient services is 1, I'm sorry, $1500 again her calendar year maximum benefit.
[AGENT][NEUTRAL] For covered outpatient services is $1500 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Now, because this is a supplemental policy, [PII], to her primary insurance, if you all do file a claim with APL, we will have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we process our claim we do have a portal that you should be able to check claim status in and our portal website is located at secured.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, and I'm sorry, could you repeat one more time, so she has 1500 in coverage, but out but office visits are not a benefit.
[AGENT][NEUTRAL] That is correct. Office visits are not covered under the supplement. If she were to receive some form of treatment in the office, we could review the treatment under her outpatient benefit, but the office visit itself would not be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alright, perfect. OK, well I'll go ahead and make a note of this, um, if I could just get a number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Well, was there any?
[AGENT][NEUTRAL] A reference number, yes ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I'm sorry, what was your name again?
[AGENT][NEUTRAL] And is there
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else, [PII], I could help you with this morning?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Um, no, ma'am, that was all. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you