AccountId: 011433970860
ContactId: 5599cc7d-82c4-4e8e-b99e-d11336a3dd9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211050 ms
Total Talk Time (AGENT): 111831 ms
Total Talk Time (CUSTOMER): 49798 ms
Interruptions: 1
Overall Sentiment: AGENT=2.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/5599cc7d-82c4-4e8e-b99e-d11336a3dd9e_20250417T14:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from Oronal, um, to verify if this patient's policy covers their primary's urgent care co-pay.
[AGENT][NEUTRAL] OK, [PII], so are you needing eligibility and benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] It is 02450103 ML 8.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And then the information that I do provide for you, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] OK, so I do show here is a dependent on the supplemental policy, and this supplemental policy, [PII] is active, effective [PII].
[AGENT][NEUTRAL] And again, what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Or no, outpatient for urgent care if it covers the co-pay.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum for calendar day for covered outpatient services is $750.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] Now, because this is a supplemental policy to their primary insurance, when the claim is submitted to APL for review, we will also need to receive a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And once we have processed our claim here at APL, we do have a website that you should be able to check claim status in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK. And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Mm, and then you.
[CUSTOMER][NEUTRAL] No, um, would you happen to have a reference number?
[AGENT][NEUTRAL] Yes, ma'am you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All right. Well, you're welcome and thank you again for calling APL if that's all I can help you with at the moment. I hope you have a wonderful day, [PII].
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you as well. Bye-bye.
[CUSTOMER][NEUTRAL] OK.