AccountId: 011433970860
ContactId: 78770bad-a605-43f3-a2c7-042f6bde76bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336130 ms
Total Talk Time (AGENT): 141742 ms
Total Talk Time (CUSTOMER): 88255 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/78770bad-a605-43f3-a2c7-042f6bde76bb_20250620T13:24_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] Good morning, [PII]. This is [PII] calling from providers line checking our status of the benefits and eligibility for the patients. Could you please help me with this?
[AGENT][NEUTRAL] OK, [PII], you have one patient to check eligibility and benefits for, is that correct?
[CUSTOMER][NEUTRAL] Yes, it's only for one patient.
[AGENT][POSITIVE] Yes, ma'am, I can.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is your callback number please, [PII]?
[CUSTOMER][POSITIVE] Yes, thank you, wait one second.
[CUSTOMER][NEUTRAL] My call back number address.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, what were the 1st 3 numbers?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] is the last part, is that correct?
[AGENT][NEUTRAL] Thank you. And the member's policy number, [PII]?
[CUSTOMER][POSITIVE] Thank you it is.
[CUSTOMER][NEUTRAL] 017.
[CUSTOMER][NEUTRAL] 19341, M as in Mike.
[AGENT][NEUTRAL] OK, [PII], I'm sorry, but your voice cut out. Yes, ma'am. [PII], [PII], you'll need to start over because your voice cut out.
[CUSTOMER][NEUTRAL] I'm, I'm sorry. It's going to be 01719341 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And any information, [PII], that I provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient date of birth is going to be [PII], and the name is [PII].
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, so again, any information provided will be a verification of benefits and not a guarantee of payment. I do show that he is a dependent on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's for our office network specialist.
[AGENT][NEUTRAL] OK, you said this is for an office visit. Is that correct?
[CUSTOMER][NEUTRAL] Yes, office person on patient and network office person.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I, I'm very sorry, but I'm having trouble understanding what you're saying. Is this for an office visit that you're needing benefits for?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, this is for office visit in network provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] An office visit on the supplemental policy is not covered.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Now, in the event that you will do file a claim with APL, you would also need to include a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And then once we've processed claims here [PII], we do have a portal that you should be able to check any claim status in for a member by going to secured. [PII] again that's secured. [PII].
[CUSTOMER][NEUTRAL] So EPL doesn't cover in-network provider of visit. Am I right? for the benefits.
[AGENT][NEGATIVE] Office visits are not covered. Office visits are not covered.
[CUSTOMER][NEUTRAL] So what about the in-network provider?
[AGENT][NEUTRAL] There is no network there is not a network affiliated with this policy with APL because it is a supplemental policy.
[CUSTOMER][NEUTRAL] Yes, yes, [PII], got it. So can I get the call reference number?
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Can you spell me if you don't mind?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you, [PII]. That's it. Thank you so much for. Bye now.
[AGENT][POSITIVE] OK. Well, you're welcome. So if that's all I can help you with, [PII]. Thank you for calling APL and I hope you have a very nice, uh, weekend.
[AGENT][NEUTRAL] Bye-bye.