AccountId: 011433970860
ContactId: 5da4a429-e09d-4af0-a5e5-1e36e8ed9743
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288579 ms
Total Talk Time (AGENT): 143156 ms
Total Talk Time (CUSTOMER): 74864 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/5da4a429-e09d-4af0-a5e5-1e36e8ed9743_20250129T13:46_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] Yeah. Hi, [PII]. Uh, very good morning. My name is [PII] calling from servicing facility. I would like to verify the member eligibility and benefits. Could you please help me with that, [PII]?
[AGENT][NEUTRAL] OK, [PII], you're needing benefits and eligibility for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes, for one moment.
[AGENT][NEUTRAL] Yes. Yes, I can help you with that. And what is your callback number, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02491476.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and any information that I provided 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] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the spouse of the subscriber on the supplemental policy. The supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient, it is a medical, meddling secondary care plan, right?
[AGENT][NEUTRAL] That is correct. And you're needing outpatient benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per cover person per calendar day.
[AGENT][NEUTRAL] For covered outpatient services is $250 with no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK, so the DME Max is $250 per day, right?
[AGENT][NEUTRAL] And [PII]. Mhm.
[CUSTOMER][NEUTRAL] For outpatient.
[AGENT][NEUTRAL] That is for covered DME services. Correct.
[CUSTOMER][NEUTRAL] Yeah, yeah, the DME Max per day is $250 for outpatient, right? Uh, [PII]?
[AGENT][NEUTRAL] For covered for right, for covered services.
[CUSTOMER][NEUTRAL] Yeah, for covered services that insurance will cover.
[AGENT][NEUTRAL] Uh-huh, $250 per per calendar day. That is correct. And when the claim is submitted to APO for review, [PII], we must also receive a copy, a detailed.
[CUSTOMER][NEUTRAL] $50 per day.
[AGENT][NEUTRAL] Copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have our portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK. So, uh, is there any possible to provide how much satisfy per day for $250?
[CUSTOMER][NEUTRAL] For today's date.
[AGENT][NEGATIVE] What do you mean? I just gave you the information. I, I don't understand what you're asking.
[CUSTOMER][NEUTRAL] OK, so you told for covered service, the insurance will cover 250 per day, right?
[AGENT][NEUTRAL] Yes, sir, but you also will have to send us a detailed copy along with the claim. You're gonna have to send us a detailed copy of our primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then there is no coincidence, right?
[AGENT][NEUTRAL] This is not a major medical insurance plan. This is a supplemental policy only.
[CUSTOMER][POSITIVE] OK. OK, uh, [PII], and that, that's it for today's call and thank you for your assistance. Have a great day. Take care, bye.
[AGENT][POSITIVE] Oh, uh-huh. You're very welcome and thank you again for calling APL Thomas. I hope you have a nice day also.