AccountId: 011433970860
ContactId: 821c9c48-b0a4-4b4e-bdf2-adc3641d8f84
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 199839 ms
Total Talk Time (AGENT): 119590 ms
Total Talk Time (CUSTOMER): 43812 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/821c9c48-b0a4-4b4e-bdf2-adc3641d8f84_20250219T15:51_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] Hi, good morning, my name is [PII]. I'm calling with Arizona Digestive Health and just needing to verify benefits please.
[AGENT][NEUTRAL] OK, [PII], do you?
[CUSTOMER][NEUTRAL] Or eligibility rather.
[AGENT][NEUTRAL] OK, do you need eligibility and benefits or just one or the other?
[CUSTOMER][NEUTRAL] I'll do both, please.
[AGENT][NEUTRAL] OK, yes ma'am, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02585237.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[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, please?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] But we have to wait.
[CUSTOMER][NEUTRAL] And ma'am, what did you say your name was again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What, um, she is a subscriber on the supplemental policy and the supplemental policy is active, effective [PII], and what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, it's gonna be outpatient colonoscopy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So she has an outpatient benefit maximum of $1000 per covered person per calendar year for covered outpatient services and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because this is a supplemental plan, [PII], to her primary insurance, we will also need for you to send a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal that you should be able to check claim status in and also have access to our EOB.
[AGENT][NEUTRAL] On the website for our portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome is there any referral, excuse me, or authorization required?
[AGENT][NEUTRAL] No ma'am, not on the supplemental policy it is not.
[CUSTOMER][POSITIVE] Awesome, and Miss [PII], do you have a reference number?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] All right sounds good thank you so much for your help.
[AGENT][POSITIVE] OK, well, you are certainly very welcome. So if that's all I can help you with, thank you again for calling APL today and I hope you have a wonderful day, [PII].
[CUSTOMER][POSITIVE] You too thanks bye bye.