AccountId: 011433970860
ContactId: 710aef83-597e-4e5a-ac62-bd027ac4a666
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331480 ms
Total Talk Time (AGENT): 161039 ms
Total Talk Time (CUSTOMER): 75340 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/710aef83-597e-4e5a-ac62-bd027ac4a666_20250423T12:14_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII].
[CUSTOMER][NEUTRAL] Uh yes hi good morning my name is [PII].
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] I wanted to look into this patient's benefit details.
[AGENT][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] OK, [PII], you're needing benefit information on a member, is that correct?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh yes ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], uh, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], I'm sorry, what was the last four numbers again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. And do you also need eligibility, [PII], or strictly benefits?
[CUSTOMER][NEUTRAL] Uh, chiropractic benefits only.
[AGENT][NEUTRAL] OK, I can help you. And what is the policy number?
[CUSTOMER][NEUTRAL] 02446527
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And any information, [PII] 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] His name is [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And he has an outpatient benefit maximum of $500 per calendar day for covered outpatient services, and there is no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] Now, because this is a supplement to his primary insurance, [PII], when the claim is submitted to APL, we will also have to receive a copy of his primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal in which you should be.
[AGENT][NEUTRAL] Able to check claim status?
[AGENT][NEUTRAL] And that for our portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does this supplemental have a chiropractic specific benefit?
[AGENT][NEUTRAL] This all falls under his outpatient.
[AGENT][NEUTRAL] benefit maximum per calendar day. It's not a separate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm assuming, uh,
[AGENT][NEUTRAL] So it's not like he has so many visits. It's, he, he doesn't have a limit on visits. It's a per calendar day maximum benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For covered outpatient services.
[CUSTOMER][NEUTRAL] Perfect and then supplemental doesn't kick in until primary benefit has been exhausted, correct?
[AGENT][NEUTRAL] This policy is designed to help with co-pays, deductibles, and co-insurance amounts of covered services.
[AGENT][NEUTRAL] So it would be filed with the primary first and then with APL again because we do have to have a copy of their, their primary EOB.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so paper mail, um, am I sending it to the address on the back of the card, the [PII] address?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK perfect um.
[AGENT][POSITIVE] Right yes ma'am.
[CUSTOMER][NEUTRAL] Uh, can I get a reference number for this call, please?
[AGENT][NEUTRAL] Yes, ma'am. You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Can you spell that for me?
[AGENT][NEUTRAL] Try
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, ma'am. [PII]
[CUSTOMER][NEUTRAL] I'm sorry, you cut out. [PII]
[CUSTOMER][NEUTRAL] I, OK.
[AGENT][NEUTRAL] No, ma'am. [PII].
[CUSTOMER][NEUTRAL] Yes, and then today's date.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] I apologize you keep cutting out um all right thank you so much for your time, [PII] I appreciate it.
[AGENT][POSITIVE] Well, you're very welcome. And again, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be it thank you.
[AGENT][POSITIVE] OK, well, you're welcome, [PII], and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You as well thank you so much.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you too.