AccountId: 011433970860
ContactId: 6b8a2598-2db1-4671-b270-b950a97ebaf4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322600 ms
Total Talk Time (AGENT): 181596 ms
Total Talk Time (CUSTOMER): 66667 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/6b8a2598-2db1-4671-b270-b950a97ebaf4_20250407T14:02_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] Hi, my name is [PII] and I'm calling from Athens Orthopedic Clinic, and I was just checking eligibility for a patient.
[AGENT][NEUTRAL] OK, then I'm sorry, [PII], you're only needing eligibility and not benefits, is that correct?
[CUSTOMER][NEUTRAL] Um, let me make this is secondary to Medicare.
[AGENT][NEUTRAL] Um, it would be secondary to a primary insurance.
[CUSTOMER][NEUTRAL] OK, yes, then I'll need benefits too, sorry, I was thought it was Medicare.
[AGENT][POSITIVE] That's OK. Oh, that's OK. Yes, ma'am, I can help you with both, and [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 021.
[CUSTOMER][NEUTRAL] 89603
[AGENT][NEUTRAL] OK, thank you. Give me one moment please to get the member's information all pulled up.
[AGENT][NEUTRAL] And excuse me, [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. 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 what type of benefit information are you needing for her, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, outpatient specialist office.
[AGENT][NEUTRAL] OK, so this supplemental policy does not cover office visits. She does have an office treatment writer on her plan, so if there is treatment rendered in the office, we could review that under her outpatient benefit.
[AGENT][NEUTRAL] And the outpatient benefit on this supplemental policy per calendar day for covered outpatient services is $1500 and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK. Say she has an X-ray, um, or an MRI done, would that be?
[AGENT][NEUTRAL] That is something that we could review.
[AGENT][NEUTRAL] That is something that can be reviewed under this plan.
[CUSTOMER][NEUTRAL] OK, so she would need to.
[CUSTOMER][NEUTRAL] So she would need to submit that to you guys or do we submit it or how does that work?
[AGENT][NEUTRAL] Uh, most providers will follow her primary and secondary, but if for any reason you all would not do that, and she could. But because it is a supplement, it would have to be filed with her primary first and then with APO because we will have to have a copy of her primary insurance company's explanation of benefits along with the claim.
[AGENT][NEUTRAL] For review and then once we have processed our claim here at APL we do have a portal, [PII], that you should be able to check our claim status in and that website for the portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And um is physical therapy and DME also would be considered treatment and that could be reviewed as well?
[AGENT][POSITIVE] Yes, she does have a DME writer on the plan.
[AGENT][NEUTRAL] Now disposable supplies would not be covered or implantable devices, but yes, she has a DME writer on this policy. Um, if she were to have lab work done at an independent lab facility, that is something else that could also be reviewed. And what was the one other thing that you asked?
[CUSTOMER][NEUTRAL] Physical therapy.
[AGENT][NEUTRAL] That would be something that could be reviewed as well.
[CUSTOMER][NEUTRAL] OK, and you guys don't have a bone and joint exclusion on the plan?
[AGENT][NEUTRAL] No, again, this is a supplement that helps with our co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] OK, alright, and can I just get a reference number please?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. So again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that'll be it. Thank you so much.
[AGENT][POSITIVE] Alright, well, you're welcome, [PII] thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.