AccountId: 011433970860
ContactId: 6b12a0bc-4819-4327-8ba8-d44c38bbfb8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313000 ms
Total Talk Time (AGENT): 140117 ms
Total Talk Time (CUSTOMER): 78044 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/6b12a0bc-4819-4327-8ba8-d44c38bbfb8a_20250227T19:15_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] Hello, this is uh [PII]. I'm calling to check members eligibility and network participation, please.
[AGENT][NEUTRAL] OK, you're needing eligibility and information regarding network, is that correct?
[CUSTOMER][NEUTRAL] I think you needed eligibility information.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] I can help you with that. And who am I speaking with again, please?
[CUSTOMER][NEUTRAL] S1
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is that correct? OK, thank you. And what is your callback number, please, E?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][POSITIVE] Thank you and
[CUSTOMER][NEUTRAL] Yes, it's 025-056887.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] So
[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, please, and their date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy, Esteban, and the supplemental policy is active with an effective date of [PII]. This plan is designed to help him with his co-pays, deductibles, and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] Just insurance.
[AGENT][NEUTRAL] So there is, because it is a supplemental policy, there is no network with APL. It would follow his primary insurance.
[CUSTOMER][NEGATIVE] So basically we are out of network.
[AGENT][NEUTRAL] I could not answer that because there's not a net you would have to contact his primary insurance company.
[AGENT][NEUTRAL] Regarding in or out of network.
[CUSTOMER][NEUTRAL] OK, I understand.
[AGENT][NEGATIVE] There is no network with this plan.
[AGENT][NEUTRAL] And if you do.
[CUSTOMER][NEUTRAL] Well you said the primary you are referring to Medicare.
[AGENT][NEUTRAL] No, so we have the primary insurance for this number to be Aetna.
[AGENT][NEUTRAL] I'm sorry, Cigna, Cigna.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] And if you all do file a claim with APL for this number, you will also need to include a copy of his primary insurance company's explanation of benefits as well. We must have that for review.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which you should be able to check our claim status and have access to our explanation of benefits, and that website for our portal is [PII].
[CUSTOMER][NEUTRAL] OK, can you check if a pre-certification is required for uh for a code.
[AGENT][NEUTRAL] There is no prior authorization required on this supplemental policy.
[CUSTOMER][NEUTRAL] Alright, and.
[CUSTOMER][NEUTRAL] I think the same for the referral is not required, right?
[AGENT][NEUTRAL] Uh, not, there is no referral required on this policy either.
[CUSTOMER][NEUTRAL] OK, I'm so sorry I didn't catch your name.
[AGENT][NEUTRAL] My name is [PII] and you would use my name along with today's date Es the phone for is your call reference number.
[CUSTOMER][NEUTRAL] My name's [PII].
[CUSTOMER][NEUTRAL] OK, [PII], may I have the first initial of your last name?
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Oh OK mine is [PII].
[AGENT][NEUTRAL] What is your
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] All right I appreciate your help.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that would be it thank you for your help.
[AGENT][POSITIVE] Oh, well, you're very welcome and thank you again for calling APL. I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you you as well bye.
[AGENT][NEUTRAL] Uh-huh