AccountId: 011433970860
ContactId: 7dedf504-0a5b-4421-8ab4-1c6dbe433c8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368440 ms
Total Talk Time (AGENT): 177076 ms
Total Talk Time (CUSTOMER): 125632 ms
Interruptions: 3
Overall Sentiment: AGENT=2.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/7dedf504-0a5b-4421-8ab4-1c6dbe433c8f_20250603T13:05_UTC.wav
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[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hello, good morning. My name is [PII]. I'm calling from a specialist office. Can you um tell me your name again please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can I have your last name initial?
[AGENT][NEUTRAL] Yes, and
[AGENT][NEUTRAL] Yes and yours?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][POSITIVE] Thank you. And how can I help you today, [PII]?
[CUSTOMER][POSITIVE] Yes, I'm calling in regards to eligibility and benefits you're one of our patients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you need eligibility and benefits for a member, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things. and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] I believe it's 01480363.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So you
[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] So
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the subscriber 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 for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Um, outpatients, specialist offices and stuff like that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So an office visit is not covered under the supplemental policy?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] For covered outpatient services on this policy, she has an outpatient benefit maximum of $500 per calendar day, with no outpatient deductible per calendar day per covered insured. But again, office visits are not covered.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So then what would be her copay for an office visit with a specialist?
[AGENT][NEUTRAL] This is, this is a supplemental policy, so that would follow whatever her primary insurance is because there are no benefits for an office visit on this policy.
[CUSTOMER][NEUTRAL] OK, so then
[CUSTOMER][NEUTRAL] So then her secondary doesn't cover the copay for the primary.
[AGENT][NEGATIVE] For an office visit. No, ma'am, it does not.
[CUSTOMER][NEUTRAL] OK, so it does not cover office visit copay.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But if she has um.
[CUSTOMER][NEUTRAL] Any like treatments or something like that, it'll cover.
[AGENT][NEUTRAL] Not treatment in the office, but if she were to have to go to an outside, you know, facility for diagnostic testing or hospital admission or outpatient surgery, things like that, then yes, ma'am, that can be reviewed under that outpatient benefit that I provided.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] For our
[CUSTOMER][NEUTRAL] So if she were to come in to our office to do, let's say an iron treatment.
[AGENT][NEUTRAL] That would not be covered under this policy. Correct.
[CUSTOMER][NEGATIVE] She's not covered.
[CUSTOMER][NEUTRAL] OK, so then she's responsible.
[CUSTOMER][NEUTRAL] OK, does not cover office visits or any.
[CUSTOMER][NEUTRAL] In office treatments correct?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can I get a reference call number please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Today is the [PII].
[AGENT][NEUTRAL] And should at some point you won't end up, you know, if you were to file the claim with us anyway, um, because it is a supplemental policy, [PII], then we would need to receive a copy of her primary insurance company's explanation of benefits along with the claim for review and then once we process claims here at APL we have a portal that you should be able to check our claim status in.
[AGENT][NEUTRAL] And the website for that is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said her outpatient.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The amount for her outpatient, what is it called again?
[AGENT][NEUTRAL] The outpatient benefit maximum per calendar day.
[CUSTOMER][NEUTRAL] There you go.
[AGENT][NEUTRAL] Uh-huh. For covered outpatient services is $500. Yes, ma'am, with no deductible.
[CUSTOMER][NEUTRAL] It's 500.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And no deductible, OK.
[AGENT][POSITIVE] Correct. Uh-huh.
[CUSTOMER][POSITIVE] Alright, well thank you very much, [PII].
[AGENT][POSITIVE] Well, you're welcome, [PII]. So again, is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Uh, no, that'll be all, thank you.
[AGENT][POSITIVE] Well, you're very welcome and thank you for calling APO I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You as well bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] OK.