AccountId: 011433970860
ContactId: 5cf02f0f-ba33-48e2-be70-3d82fb69e9a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241880 ms
Total Talk Time (AGENT): 140081 ms
Total Talk Time (CUSTOMER): 53238 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/5cf02f0f-ba33-48e2-be70-3d82fb69e9a4_20250327T17:13_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], my name is [PII] calling from a medical provider's office. I was just calling to see uh a patient's benefits and eligibility.
[AGENT][NEUTRAL] OK, [PII], you're needing benefits and eligibility for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things, and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] It'll be [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Policy number is going to be.
[CUSTOMER][NEUTRAL] 02483265
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][POSITIVE] No problem thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is a dependent on the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office
[AGENT][NEUTRAL] OK, is this for an office visit?
[CUSTOMER][NEUTRAL] Yes, and if any procedure codes that we perform if it covers like the co-payment or deductible.
[AGENT][NEUTRAL] OK, so on this policy, the office visit itself is not a cover benefit. However, for treatment that is rendered within the office that can be reviewed under the outpatient benefit maximum which is $1750 per calendar year with no deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now because this is a supplemental policy, Cassandra to the outpatient, I'm sorry, to the, I was looking at the word outpatient. Uh, yes, to their primary insurance when the claim is submitted, yeah, I had a one track mind for a second when the claim is submitted to us for review, we will also have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In the medical insurance.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] As well. And then, mhm.
[CUSTOMER][POSITIVE] Mm, OK, cool.
[AGENT][NEUTRAL] Since this plan helps them with their co-pays, deductibles and co-insurance amounts of covered services, we have to, that's why we have to have that for review. And then once we have processed our claim, we do have a portal, Cassandra that you can check claim status in and our portal website is secured.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK and then are you able to provide me uh a sorry, a reference number? I can't talk either today. Goodness.
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] That's OK. We're almost to Friday. Hold on. Uh, you're gonna use my name along with today's date, and again, my name is [PII].
[CUSTOMER][NEUTRAL] Amen.
[CUSTOMER][POSITIVE] Mhm. And then today's date, perfect. Thank you so much, [PII]. Have a great day, OK?
[AGENT][POSITIVE] Well, you are certainly welcome. Yes, ma'am. If that is all I can help you with, thank you again for calling APL and I hope you have a great afternoon also.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.