AccountId: 011433970860
ContactId: 681cc6c1-e064-4fe1-aeb4-cb327f4aede4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 221559 ms
Total Talk Time (AGENT): 127700 ms
Total Talk Time (CUSTOMER): 38139 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/681cc6c1-e064-4fe1-aeb4-cb327f4aede4_20250217T20:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, it's [PII] from Doctor [PII]'s office. I'm calling for benefits on a patient.
[AGENT][NEUTRAL] OK, [PII], do you also need eligibility or do you already have that?
[CUSTOMER][NEUTRAL] I need eligibility too.
[AGENT][NEUTRAL] OK, yes, I can help you with both of those things. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] 02049367 ML 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and [PII], any 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 their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, the policy number that you gave me is an old policy number that's no longer active. She does have another policy that is active, but the policy number you gave me, termed as of [PII].
[AGENT][NEUTRAL] Her current active policy is 021-975-47.
[AGENT][NEUTRAL] It is active with an effective date of [PII].
[AGENT][NEUTRAL] And just one moment while the information's pulling up please.
[AGENT][NEUTRAL] OK. And again, [PII], did you need inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Office visit.
[AGENT][NEUTRAL] Office visit, OK.
[CUSTOMER][POSITIVE] Specialist yeah.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so this supplemental policy does not cover office visits. She does have an office treatment writers that we could review the treatment that is rendered under her outpatient benefit, but the office visit itself is not covered.
[CUSTOMER][NEUTRAL] OK, and the treatment, what is the maximum per year?
[AGENT][NEUTRAL] The outpatient benefit max per calendar year per covered person for covered outpatient services is $2000 with no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And if you all do end up filing a claim with us um on this policy [PII] you will also need to include a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim, then we do have a portal that you should be able to check our claim status and have access to our EOB.
[AGENT][POSITIVE] And our portal website is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] That's it for today thank you very much.
[AGENT][POSITIVE] Well, you're very welcome. Absolutely. It's my pleasure and thank you again for calling APL. I hope you have a wonderful evening.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.