AccountId: 011433970860
ContactId: 612ec306-ee66-4cc9-a706-841f32e4281b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340700 ms
Total Talk Time (AGENT): 143355 ms
Total Talk Time (CUSTOMER): 136645 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/612ec306-ee66-4cc9-a706-841f32e4281b_20250212T14:19_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. That's [PII] initial of my last name is [PII]. I'm on a recorded line calling because we have a patient coming into the office for infusion therapy, and I need to verify their benefits for a few procedure codes, please.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so you're needing to verify benefit information, [PII] for a member?
[CUSTOMER][NEUTRAL] Yep, that's it.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, Boris?
[CUSTOMER][NEUTRAL] 018670000
[CUSTOMER][NEUTRAL] ML8.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] the information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], and her birthday is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And you said this is for treatment done within the office setting, is that correct?
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Uh, yes, it will be done in the office but not billed for an office visit.
[AGENT][NEUTRAL] OK, because office visits are not covered under this policy, she does have an office treatment writer in which we can review treatment rendered in the office and under her outpatient benefits, and her outpatient benefit maximum per calendar day for covered outpatient services per person is $500 with no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Yeah, that's it.
[CUSTOMER][POSITIVE] All right, got you.
[AGENT][NEUTRAL] And when the claim just a couple of additional things for you [PII], when the claim is submitted to APO for our review, we must also have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which you should be able to check claim status and have access to the EOB for APL by going to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, got you.
[CUSTOMER][NEUTRAL] And then before I go, I just have a few other quick questions about their policy.
[CUSTOMER][NEUTRAL] Uh, let's see. Um, do you guys, uh, do you guys require prior authorization for any codes or for treatments? Got you.
[AGENT][NEUTRAL] No, because we're not a major medical insurance, so it follows the primary.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Oh, let's see, um.
[CUSTOMER][NEUTRAL] Do you know if the provider is able to buy and build the medication? that's something you guys handle?
[AGENT][NEGATIVE] No, sir, it is not.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Uh, are referrals required to see a specialist for, uh, this policy?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Again, it follows the primary because we're not a major medical insurance. This is strictly a supplemental policy.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] That helps with co-pays, deductibles and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] Primary.
[CUSTOMER][NEUTRAL] And then that one's gonna be no because you follow the primary.
[CUSTOMER][NEUTRAL] All right. Um, do do do. I think that's just about it right there. All right. So, um,
[AGENT][NEUTRAL] OK, yeah. All right, bus. Well, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, just gonna read back through it. Uh, authorization is not required for our treatment. Uh, the patient has the $500 limit per day, um, covered at 100%.
[AGENT][NEUTRAL] For covered services. Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yep, for covered services.
[CUSTOMER][NEUTRAL] Yeah, I think that's about it. um, can I get a reference number for the call before I go?
[AGENT][NEUTRAL] Yes, but she would use my name that I gave you along with today's date. And if you need the first initial to my last name, it is [PII]
[CUSTOMER][POSITIVE] All right, [PII], thanks for all your help today. Really appreciate it and.
[AGENT][POSITIVE] Well, you are certainly, absolutely.
[CUSTOMER][POSITIVE] Hope you have a good one.
[AGENT][POSITIVE] I hope you have a great day too, [PII] and thank you again for calling APL.
[CUSTOMER][POSITIVE] Alright thank you and goodbye.
[AGENT][POSITIVE] Alright, you're welcome. Uh-huh. Bye bye.