AccountId: 011433970860
ContactId: 5d433cef-8d20-46a8-a17c-b4e3de68123e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508070 ms
Total Talk Time (AGENT): 277239 ms
Total Talk Time (CUSTOMER): 127594 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/5d433cef-8d20-46a8-a17c-b4e3de68123e_20250616T13:30_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, good morning. Uh, my name is [PII]. I'm calling from Doctor [PII]'s office. I need to, uh, get benefits on a patient, please. [PII], could you give [PII] an appointment at?
[AGENT][POSITIVE] OK, [PII], I'll be glad to help you. Go ahead and give me a good policy number.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So I was giving 022815881.
[AGENT][POSITIVE] All right, [PII], thank you for that information.
[AGENT][NEUTRAL] Now while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty, [PII], thank you for that. Let me try that policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It's, it's one too many numbers, so let me just see if I can figure this out. What's your patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, give me just a second. Let's see.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] All right, I think I have figured it out. There's way too many eights at the back, so.
[AGENT][NEUTRAL] All right, let's see. And what is [PII]'s date of birth? Just make sure.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] Looks like they flipped to a different number even so bear with me and hold on just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] That's so.
[AGENT][NEUTRAL] You're calling for medical benefits, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] All right, I have found the current policy number. OK, first off, um,
[AGENT][NEUTRAL] [PII], I'm gonna give you the correct policy number on this member here at APL. It's gonna be 02.
[CUSTOMER][POSITIVE] I appreciate that thank you.
[AGENT][NEUTRAL] Oh, yes, ma'am, because this is the number we're gonna need when you file it on your claim, OK?
[CUSTOMER][NEUTRAL] Oh OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, the correct policy number is going to be 022.
[AGENT][NEUTRAL] 846.
[AGENT][NEUTRAL] 15.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Alrighty. Now you did say you want a benefit on Lucretia, is that correct?
[CUSTOMER][NEUTRAL] Actual
[CUSTOMER][POSITIVE] Sure, that is correct, thank you.
[AGENT][NEUTRAL] Alright, yes ma'am, let me get those pulled up. OK, now of course what we are is just her medical supplemental plan, [PII], um, and her original effective date here at APL is gonna be [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on the client.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] But what exact benefit are you needing today?
[CUSTOMER][NEUTRAL] Um, so we, she, we are, um, orthopedics, um, she's coming in for a consultation, so, um, specialist office visit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for an office visit? OK. All right, let's see.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][POSITIVE] They have that benefit.
[AGENT][NEUTRAL] Alright, looks like under this plan of course what we are is just a supplemental plan so the other thing.
[AGENT][NEUTRAL] That we would pick up and pay on is anything for sickness and injury that is applied toward her deductible, co-pay, or co-insurance at her primary insurance carrier for sickness and injury only. Nothing routine here is covered at all. But under her medical supplemental plan here, she does not have office visit benefits, but she does have office treatment. What that means is the actual office visit is not covered here at all, but
[AGENT][NEUTRAL] Anything she has done in the office such as lab and X-ray.
[AGENT][NEUTRAL] Um, would be subject to that, uh, zero deductible and $5000 max benefit here. We just don't pay for office visits here at all.
[CUSTOMER][NEUTRAL] Oh, OK, so if the, um, OK, so the visit is the actual consultation is not covered, but the X-rays will be covered, any labs, any procedures, um, yeah, if the what if the uh primary doesn't cover anything you still cover those?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, anything, right.
[AGENT][NEUTRAL] If it, no, ma'am, if it does not apply towards the deductible co-pay or co-insurance at the primary, it's not covered here at all. So it has to be covered there.
[CUSTOMER][NEUTRAL] Uh, it will, it will be, yeah, she has a high deductible, so this will go towards her deductible and does the plan pay 100% like what's the fee schedule?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh, OK. Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it, it what we're gonna do is coordinate with that primary so anything.
[AGENT][NEUTRAL] That is applied towards that deductible copay or coinsurance is what we would pick up at 100% with that max of $5000 per calendar year payable.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] And our benefits still payable actually under the plan or has she maxed out?
[AGENT][NEUTRAL] Let's see what she's made.
[CUSTOMER][POSITIVE] Good morning.
[AGENT][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] Looks like as of today, she's only met $39.92 of that benefit. So she does, as of today still have a lot of benefit left.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] that.
[CUSTOMER][NEUTRAL] OK, um, where do we submit our claims?
[AGENT][NEUTRAL] OK, all claims, um, along with that primary EOB will come to APL.
[AGENT][NEUTRAL] Claims depa[PII].
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And we're in [PII].
[AGENT][NEUTRAL] And our
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, is there an electronic ID number?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And my electronic payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes, ma'am, and you can submit that claim electronically and just make sure you have that claim along with that primary ELB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and does this insurance have a network or out of network or does just it just pay based on deductibles, OK, OK, got it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am. We're just a, just a supplemental. Correct. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, well I appreciate your help today thank you so much.
[AGENT][NEUTRAL] Oh, is that all that I can help answer for you today?
[AGENT][POSITIVE] Oh, yes, ma'am, and thank you for calling APL Keisha, you have a great day.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you, ma'am. Bye bye.