AccountId: 011433970860
ContactId: 7de02c24-e44d-4cda-9acf-0fcc8a1d854b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413760 ms
Total Talk Time (AGENT): 209017 ms
Total Talk Time (CUSTOMER): 118863 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/7de02c24-e44d-4cda-9acf-0fcc8a1d854b_20250602T19:18_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm calling to confirm this patient has secondary gap coverage with APL and if their policy covers, uh, physical therapy, outpatient hospital benefits.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and get some benefit information, is that correct?
[CUSTOMER][POSITIVE] Mhm, yes ma'am, that's correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][POSITIVE] Thank you, [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] [PII]. OK, thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] I have 02299144 M like Mike L like Larry, and the number 8.
[AGENT][NEUTRAL] OK, thank you, [PII]. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hi [PII], are you calling for a future data service?
[CUSTOMER][NEUTRAL] Um, yes, ma'am, this is for tomorrow, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK [PII], so any information again that is provided would be a verification of benefits and not a guarantee of payment. What is your patient, I'm sorry, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. So I do show that she was a subscriber on the, on the supplemental policy. Now the policy number that you provided for me, it's an older policy, Melissa, and it's no longer active. That policy number was active from [PII] to its term date of [PII], but she does have another policy that is active under a different number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And so the current active policy.
[CUSTOMER][NEUTRAL] OK, I'll take.
[AGENT][NEUTRAL] Is 02595724.
[AGENT][NEUTRAL] And it has an effective date of [PII], and again, it is active.
[CUSTOMER][NEUTRAL] [PII] and is active. OK, and does she have an outpatient dollar amount for therapy on her policy because I know sometimes they don't cover it, mhm.
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK. It's for outpay, OK.
[AGENT][NEUTRAL] OK, so is this going to be, OK, so she does have a treatment writer on her policy, so out the outpatient benefit maximum per calendar year for covered outpatient services is $2500.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And there is no outpatient deductible for covered person per calendar year.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Now, because I don't know how familiar you are, [PII], with our coverage, but because it is a supplemental policy to her primary insurance, when the claim is submitted to us for review, we will have to have
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed the claim here we do have a portal that you should be able to check the claim status in for APL and the website for that is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then the out the, uh, outpatient amount, 2500, do they still have the full amount remaining or have they used any for the year so far?
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] I can check that for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][NEUTRAL] OK, so as of now she has used $614.95 for this calendar year.
[CUSTOMER][NEUTRAL] $614.95. OK, got you.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Alright, and then a couple more questions for you, then we're all set for the group name and number, do they have anything on file with this policy?
[AGENT][NEUTRAL] The group number is 22841.
[AGENT][NEUTRAL] The name of the group is NFI.
[AGENT][NEUTRAL] Insurance Group LLC.
[AGENT][NEUTRAL] Again, that's NSI.
[AGENT][NEUTRAL] Insurance Group LLC.
[CUSTOMER][NEUTRAL] And that's uh N like I mean uh N like Nancy, S like Sierra, right?
[AGENT][NEUTRAL] Mhm, yes, N like Nancy, S like Sierra, yeah, S as in Sierra, I as in India.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Just wanna make sure it wasn't if in.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Perfect. Alright, and then the claims address is it the [PII]?
[AGENT][NEUTRAL] [PII]. That is correct.
[CUSTOMER][POSITIVE] Perfect. Alright, that's exactly what I needed for this patient today, [PII]. Can I have a call reference number and the first initial of your last name if possible?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The call reference number, yes, will be my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Perfect. All right, thank you so much for your time and your help, [PII]. You were great, and I hope you enjoy the rest of your day.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh, well, thank you, [PII]. It's my pleasure in speaking to you and if that is all I can help you with, then I hope you have a great rest of your day as well.
[CUSTOMER][POSITIVE] Thank you. You too. Bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.