AccountId: 011433970860
ContactId: 587fe66c-9b95-4b07-95d1-8c73ccad9571
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306359 ms
Total Talk Time (AGENT): 141984 ms
Total Talk Time (CUSTOMER): 122468 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/587fe66c-9b95-4b07-95d1-8c73ccad9571_20250225T19:58_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Lake Shore Bone and Joint. We had a patient reach out to us in regards to this plan through APL. Um, he did provide us with an insurance card. Um, I'm trying to just verify that the address that's listed for the submit claims to address is the correct address because we did have a different one listed in our system, so if we needed to get it changed, um, I just needed to reference that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], so you have a member that you're just needing to verify what our correct mailing address is for claims, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And then what is the um policy number please for your patients?
[CUSTOMER][NEUTRAL] Um, it looks like it's referenced as 02554166.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] And I do see this is a limited benefit plan as well.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does that mean that like the services for this plan are possibly only hospital related or are clinical services also allowed?
[AGENT][NEUTRAL] I will have to pull, I will just have to look at the benefits on this plan because each of the limited benefit plans are different. So any information, [PII], that I do provide for you 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] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the patient is an [PII].
[CUSTOMER][NEUTRAL] Um, hold on, let me get to the date of birth.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do see that he is the policy holder on this supplemental policy. I'm sorry, on this, let me get my wording right here. This limited benefit plan and the policy is active. [PII], the effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of services for inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] For an office visit.
[CUSTOMER][POSITIVE] Mhm, correct.
[AGENT][NEUTRAL] OK. So for outpatient accident and sickness treatment for a physician's office, the benefit is $50 per day and a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And then um I mean that's fine as far as that's concerned I guess then that would be um just to verify the claims to address.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the mailing address for this policy is going to be the claims we sent to IMA.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that has the payer ID of the 64556.
[AGENT][POSITIVE] That is correct, yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. OK, well, I appreciate your time and the information. Um, your name was again? I'm sorry.
[AGENT][NEUTRAL] Oh, you are very welcome, [PII], and my name and today's date will be your call reference number, [PII] if you need one. Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right. Thank you so very much. You have a wonderful day.
[AGENT][NEUTRAL] OK. Well, you're very welcome. And then I hope you do too. And one last thing, [PII], if you all do file a claim for this member, once it has been processed, we also have a portal that you should be able to check claim status and, and our portal website is secured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] A um [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]? OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] [PII]. OK, perfect. Thank you.
[AGENT][POSITIVE] Uh-huh. OK. Well, you're very welcome. So thank you again for calling APL. Have a great afternoon.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.