AccountId: 011433970860
ContactId: 5aae9402-c07f-402d-ab2f-172d8fa49e92
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264089 ms
Total Talk Time (AGENT): 90243 ms
Total Talk Time (CUSTOMER): 80079 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/5aae9402-c07f-402d-ab2f-172d8fa49e92_20250219T18:30_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII]. I'm calling from a provider's office and I was calling to get some information regarding a patient's um, coverage.
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility today, [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, it looks like it's.
[CUSTOMER][NEUTRAL] Um, 02212366.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[AGENT][NEUTRAL] And do you show the policy is active effective date is [PII].
[AGENT][NEUTRAL] And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] So we're actually a specialist office. This, this would be for a specialist office visit, so I don't know, would this plan cover that?
[AGENT][NEUTRAL] OK, so for.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] And what was your name again? Sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So she does have benefits for treatment in an office or clinic setting that would fall under the outpatient benefit one moment.
[CUSTOMER][NEUTRAL] I guess I need to check to see if we're in network with the plan.
[AGENT][NEUTRAL] I'm showing the outpatient calendar year maximum is $7150.
[AGENT][NEUTRAL] Um, and with this, um, plan.
[AGENT][NEUTRAL] Oh, we don't, we follow the guidelines of the primary, so you would need to check with her primary to see if you're in network with them.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, they have United Healthcare, which we are.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So what um is is there any referral or authorization required?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] What's the claim's mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Um, can you repeat the zip?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you have a payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And what is the name of the plan?
[AGENT][NEUTRAL] Uh, Medlink Gap.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so is this like a is it like a commercial PPO plan?
[AGENT][NEUTRAL] We're the um gap insurance.
[AGENT][NEUTRAL] So but it is through their their it's commercial through their job and we work in conjunction with the.
[AGENT][NEUTRAL] Um, they, uh, major medical.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK, any reference number for the call?
[AGENT][NEUTRAL] Reference would just be my name [PII] last initial [PII] [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Thank you for calling APL have a good day.