AccountId: 011433970860
ContactId: 72a2088d-750d-4e77-a0c8-390e681f7c9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284609 ms
Total Talk Time (AGENT): 156131 ms
Total Talk Time (CUSTOMER): 57602 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/72a2088d-750d-4e77-a0c8-390e681f7c9d_20250213T17:59_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from Doctor [PII]'s office in regards to um a patient that's coming in today. I wanted to verify um if they're still active and how many copays you guys cover.
[AGENT][NEUTRAL] OK, so you're needing eligibility and benefit information for a member that's coming in, is that correct?
[CUSTOMER][NEUTRAL] Today, yes, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the member's policy number please?
[CUSTOMER][NEUTRAL] 01659366 M like Mary, L like Larry 8.
[AGENT][NEUTRAL] OK thank you one moment last while I get all the members' information pulled up please.
[AGENT][NEUTRAL] OK, [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 date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. Now the policy number you gave me is an old policy number that's no longer active. That policy termed 112024.
[AGENT][NEUTRAL] The current active policy list is 250.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1804.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it is active with an effective date of [PII].
[AGENT][NEUTRAL] And give me just a moment to get that information pulled up, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's the member ID number, the 250-1804?
[AGENT][NEUTRAL] Yes, that is what you will need to use if you submit a claim to APL. The other policy number you gave me termed as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][POSITIVE] And she is also covered under this policy that I just gave you. It's active.
[AGENT][NEUTRAL] And on this supplemental policy, again, you were needing benefits for an office visit, is that correct?
[CUSTOMER][NEUTRAL] Yes, I wanted to know how many copays you guys cover.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK, and is this for a specialist office visit or for a primary care?
[CUSTOMER][NEUTRAL] No, for a regular office visit.
[AGENT][NEUTRAL] OK, so this supplemental policy has a physician's office benefit of up to $25 per visit and a maximum of 4 visits for covered person per calendar year.
[CUSTOMER][NEUTRAL] Max 4 visits per calendar year.
[AGENT][NEUTRAL] Mhm, yes ma'am and when the claim, and again this is for [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and when the claim is submitted to APO list for review, we will also have to have receive a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim,
[AGENT][NEUTRAL] You will, you can, or let me, I'm falling all over my words, [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] It's OK. It's OK.
[AGENT][NEUTRAL] Once we've processed our claim, we also have a portal that you should be able to check claim status in and have access to our EOB and that website for our portal is secured. [PII].
[CUSTOMER][POSITIVE] Perfect, and can I have a reference number for this call?
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much that's all I needed I appreciate you.
[AGENT][POSITIVE] OK. Well, absolutely, you're very welcome. So if that is all I can help you with at this time, then thank you again for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.