AccountId: 011433970860
ContactId: 621a87ff-cc4f-4f7c-99a0-ece546667f52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419320 ms
Total Talk Time (AGENT): 139748 ms
Total Talk Time (CUSTOMER): 118338 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/621a87ff-cc4f-4f7c-99a0-ece546667f52_20250617T17:24_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from provider office. I need to verify the patient eligibility information.
[AGENT][NEUTRAL] OK. How do you spell your name?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yeah. The phone number is [PII].
[AGENT][NEUTRAL] And do you have their policy number?
[CUSTOMER][NEUTRAL] With the extension of 2020.
[AGENT][NEUTRAL] OK, I'm sorry, what was the extension?
[CUSTOMER][NEUTRAL] Yeah, I have the.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And the policy number?
[CUSTOMER][NEUTRAL] Yeah, one moment. The policy number is 02579243.
[AGENT][POSITIVE] Thank you, [PII]. Hold on one moment please.
[CUSTOMER][NEUTRAL] You OK?
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] The patient name is?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And can I verify her date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefits?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can help you with that. The effective date was [PII].
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment. This policy coordinates with the primary insurance.
[AGENT][NEUTRAL] Whatever the primary applies to their deductible, co-pay or co-insurance will pay up to a certain amount. Is this for outpatient or inpatient or doctor's office?
[CUSTOMER][NEUTRAL] At the doctor's office.
[AGENT][NEUTRAL] OK. Is it for an office visit or services done in a doctor's office?
[CUSTOMER][NEUTRAL] Any
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is it for an office visit?
[CUSTOMER][NEUTRAL] It's an outpatient office, is it?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient service.
[AGENT][NEGATIVE] If it's for an office visit, it's not covered.
[AGENT][NEUTRAL] So it depends on.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] The place of service. Is the place of service 22 or 11?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's an outpatient service.
[CUSTOMER][NEUTRAL] Non-emergency.
[AGENT][NEUTRAL] OK, but is it for an office visit or is it for services?
[AGENT][NEGATIVE] Office visits are not covered.
[AGENT][NEUTRAL] So it would depend on the per
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's an office visit.
[AGENT][NEUTRAL] OK, so the office visit wouldn't be covered.
[CUSTOMER][NEUTRAL] Go
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It depends on the procedure code if it's covered or not.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] But office visits aren't.
[CUSTOMER][NEUTRAL] And is there any group number?
[AGENT][NEGATIVE] Office visits aren't covered under this policy.
[CUSTOMER][NEUTRAL] Yeah, it's OK fine.
[AGENT][NEUTRAL] OK, and the group number is?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] 262-60.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I know the patient plan type?
[AGENT][NEUTRAL] Midlink gap.
[CUSTOMER][NEUTRAL] Sorry, can you spell it?
[AGENT][NEUTRAL] It's a gap policy GAP?
[AGENT][NEUTRAL] And it's midlink.
[CUSTOMER][NEGATIVE] It's a gap.
[AGENT][NEUTRAL] M E D
[AGENT][NEUTRAL] L I N K Medley.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And can I know the patient is subscriber or dependent?
[AGENT][NEUTRAL] They are the subscriber.
[CUSTOMER][NEUTRAL] Can I know, is it the primary or secondary payer?
[AGENT][NEUTRAL] This is a secondary policy.
[CUSTOMER][NEUTRAL] For the patient.
[CUSTOMER][NEUTRAL] OK. Can I get the claim mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. Can I know the timely filing to limit to submit a claim?
[AGENT][NEUTRAL] We
[AGENT][NEGATIVE] We do not have timely filings.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello? Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I was, I
[CUSTOMER][NEUTRAL] Nothing. Can I get your full reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name and today's date. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, [PII], for calling APS. You have.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You have a good day.
[CUSTOMER][POSITIVE] Yeah, thank you, bye.
[AGENT][NEUTRAL] Bye-bye.