AccountId: 011433970860
ContactId: 8235a632-e456-4525-9fd8-a3764759537a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246080 ms
Total Talk Time (AGENT): 136062 ms
Total Talk Time (CUSTOMER): 56430 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/8235a632-e456-4525-9fd8-a3764759537a_20250225T21:23_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon, [PII]. I'm calling from Rio Valley Dermatology just to verify, um, eligibility and benefits for one of the patients.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefit information, is that correct?
[CUSTOMER][NEUTRAL] Correct, and can I have the first initials of your last name please?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes OK.
[AGENT][NEUTRAL] Yes, ma'am. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] This is [PII], ma'am.
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] And the first initial lists you to your last name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII] and it is a direct line.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That was [PII]?
[CUSTOMER][POSITIVE] Correct, ma'am.
[AGENT][NEUTRAL] OK, thank you. And [PII], I can help you with eligibility and benefits. What is your patient's policy number?
[CUSTOMER][NEUTRAL] I do have the 01868846.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], any information that I do provide for you 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] Any [PII], uh, [PII], ma'am.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Hi, She, is it dependent on the supplemental policy, and the supplemental policy is active, [PII], 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] OK.
[CUSTOMER][NEUTRAL] Um, office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this policy, office visits are not covered?
[AGENT][NEUTRAL] However, that she does have an office treatment writer in which if there is treatment rendered in the office that could be reviewed under her outpatient benefit max, and on this policy, the outpatient benefit maximum per calendar year for covered outpatient services is $2550.
[CUSTOMER][NEUTRAL] OK and.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and if she does get a procedure done, does she have a deductible?
[CUSTOMER][NEUTRAL] Or does it cover uh procedures?
[AGENT][NEUTRAL] No ma'am, um, this is a this is the supplemental policy and the $2550 is our calendar year max.
[AGENT][NEUTRAL] For covered outpatient services. Mhm. Now, if you all do file a claim with us for review, you will also need to include a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Oh OK OK got you.
[CUSTOMER][NEUTRAL] OK ma'am.
[AGENT][NEUTRAL] And then once we have processed our claim, [PII], we have a portal that you should be able to check our claim status and have access to our EOB by going to secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you very much um and do you have a reference number for this call?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, thank you very much have a good day ma'am.
[AGENT][POSITIVE] Well you too and thank you for calling APL if that's all I can help you with.
[CUSTOMER][POSITIVE] Yes ma'am thank you bye bye.
[AGENT][NEUTRAL] All right [PII], bye bye.