AccountId: 011433970860
ContactId: 7b181632-190f-4314-8115-56a55639faa9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407200 ms
Total Talk Time (AGENT): 198253 ms
Total Talk Time (CUSTOMER): 98845 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/7b181632-190f-4314-8115-56a55639faa9_20250328T13:06_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] Hey, my name is [PII] and last initial [PII]. I'm calling to PFO provider office. I just want to know the eligibility and benefits for this one member. Could I help you with that.
[AGENT][NEUTRAL] OK, did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], and you're needing eligibility and benefits for one member, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you with that, [PII] and what is your callback number?
[CUSTOMER][NEUTRAL] It will be [PII] direct line.
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Sure. It will be 02540133.
[AGENT][POSITIVE] Thank you one moment while I get the member's information all pulled up please.
[AGENT][NEUTRAL] And any information, [PII], that I provide for you will 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], and date of birth will be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] just.
[AGENT][NEUTRAL] OK, [PII], so the um Mark is the subscriber on this limited benefit excuse me, the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK, and I'm looking for Maran benefits and the code will be 73721.
[AGENT][NEUTRAL] I'm sorry, what type of benefit information?
[CUSTOMER][NEUTRAL] MRI scan.
[AGENT][NEUTRAL] OK, so he, he has an outpatient benefit maximum.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Of $1000 per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] So there is no deductible for this number?
[AGENT][NEUTRAL] This is the supplemental policy to the primary insurance that's designed to help with co-pays, deductibles, and co-insurance amounts of covered services. So when the claim is filed with APO, we will also have to have a copy of his primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] So this a dollar and as you said in this out of pocket is $1000 right?
[AGENT][NEUTRAL] I'm stating that the benefit maximum that this policy would pay per calendar day for covered outpatient services is $1000.
[CUSTOMER][NEUTRAL] Uh, I got the point. So what are the in out of pocket then?
[AGENT][NEUTRAL] Again, we're not a major medical insurance company, [PII]. This is the supplemental policy to his primary insurance.
[CUSTOMER][NEUTRAL] So you can gain, you know, you meet the for each member like you are saying with that.
[AGENT][NEUTRAL] I didn't understand what you said, [PII].
[CUSTOMER][NEUTRAL] So you can, you cannot give me the benefits as you're stating with that?
[AGENT][NEUTRAL] I did just give you the benefit information.
[CUSTOMER][NEUTRAL] Yeah, so I'm asking you, the co-pay will be $0 right?
[AGENT][NEUTRAL] And I'm explaining to you that there is no copay on this policy because this policy is not his primary insurance. This policy helps him with his co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So once you file the claim with his primary insurance, then you would file it with APL and you will also need to send us a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] OK. Uh, and what about the plan type for this member?
[AGENT][NEUTRAL] And then [PII] once we.
[AGENT][NEUTRAL] This is a supplemental.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Plan
[AGENT][NEUTRAL] Called Medlink.
[CUSTOMER][NEUTRAL] Yeah, but
[AGENT][NEUTRAL] We are not a major medical insurance cover, excuse me, we are not a major medical insurance company.
[CUSTOMER][NEUTRAL] Yeah like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, like that. OK, fine. And yeah, go with what you are saying.
[AGENT][NEUTRAL] And then once we have processed our claim here at APLM, we have a portal that you should be able to check our claim status in by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK, fine. So,
[CUSTOMER][NEUTRAL] OK, let me know the reference of this call.
[AGENT][NEUTRAL] My name that I gave you along with today's date and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK. And may I know this record operation or?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Yeah, I just want to know that is it requiredation for this member?
[AGENT][NEUTRAL] No prior authorization is required. This would follow his primary insurance.
[CUSTOMER][NEUTRAL] OK, like that. So, OK.
[CUSTOMER][POSITIVE] Yeah, that's OK. Thank you for your assistance. Have a good day.
[AGENT][POSITIVE] Well, you're welcome. Yes, sir. If that's all I can help you with then. Thank you again for calling APL and I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.