AccountId: 011433970860
ContactId: 82d5a0f1-da75-4bbc-9e01-0af4bef8a15d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396380 ms
Total Talk Time (AGENT): 173088 ms
Total Talk Time (CUSTOMER): 152154 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/82d5a0f1-da75-4bbc-9e01-0af4bef8a15d_20250523T17:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from Memorial Division of Colon and rectal Surgery. I'm just trying to verify a patient's eligibility and benefits.
[AGENT][NEUTRAL] OK, [PII], and what it, uh, can you spell your name for me first off?
[CUSTOMER][NEUTRAL] It's spelled [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you said it's [PII], is that correct? Or [PII]?
[CUSTOMER][NEUTRAL] It's it's [PII], but it's, it's fine.
[AGENT][NEUTRAL] OK. All right. Thank you. And [PII], what is a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Callback number will be [PII].
[AGENT][NEUTRAL] Thank you. And you're needing to verify eligibility and benefits or only eligibility?
[CUSTOMER][NEUTRAL] Um, eligibility and benefits.
[AGENT][POSITIVE] Yes, I can help you with both and what is your good callback number please?
[CUSTOMER][NEUTRAL] A good call back number [PII].
[AGENT][NEUTRAL] OK, alright, thank you, and then the policy number for the member?
[CUSTOMER][NEUTRAL] Um, so he was not able to find me a policy number. He said all that was on there was a group which was 15297, which I, I doubted that he, I, I don't know. I think maybe he saw another number there and probably thought it was for something else because I'm pretty sure 15297 is not it.
[AGENT][NEUTRAL] OK. Do you have a
[AGENT][NEUTRAL] Correct. It is not. So, did you happen to, do you have a copy of his ID card?
[CUSTOMER][NEUTRAL] Um, no, because this is a patient that I scheduled his appointment over the phone. So he is referred by another doctor and our doctor told me to give him a call to schedule him a telehealth appointment, but because of his supplement insurance, I have to verify it to make sure it's running active.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the gentleman's last name?
[CUSTOMER][NEUTRAL] His last name is [PII], that's spelled [PII]
[AGENT][NEUTRAL] And you said he gave you group 15297?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First name is [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] broker is
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on here, [PII] the.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Any information provided will be a verification of benefits and not a guarantee of payment. What is his date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show he is the subscriber on the supplemental policy.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] The correct policy number that you need for this number is 022.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 03926.
[AGENT][NEUTRAL] And you said that you do or do not name benefits?
[CUSTOMER][NEUTRAL] Um, I do, but, uh, when, when is his insurance effective plan?
[AGENT][NEUTRAL] Again, the plan effective date is [PII].
[CUSTOMER][NEUTRAL] [PII] and does he have a termination date?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] He does not. The policy is active.
[CUSTOMER][NEUTRAL] And because this is a supplement insurance, is there like a co-pay for him or no?
[AGENT][NEUTRAL] This policy is designed to help with co-pays, deductibles and co-insurance amounts of coverage services.
[AGENT][NEUTRAL] So when the claim is submitted to APL for review, we do have to also receive a copy of his primary insurance company's explanation of benefits along with that claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And again, are you needing benefits for
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, it's for office.
[AGENT][NEUTRAL] OK, so on the supplemental policy, office visits are not covered.
[AGENT][NEUTRAL] If he receives some type of treatment done in the office, that is something that could be reviewed under his outpatient benefit and the outpatient benefit maximum per calendar year for covered outpatient services is $6000 with no outpatient deductible, but again, office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK and then uh let me see, can I get a reference number for this call?
[AGENT][NEUTRAL] Yes ma'am, you're gonna use my name that I gave you along with today's date and then [PII] is you will end up filing a claim with us for him again we would have to have the primary EOB as well. And then once that we have processed the claim, we have a portal that you should be able to check claim status in and that website for that is located at secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much and then I'm so sorry, what was your name again?
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII], what's the first letter of your last name?
[AGENT][NEUTRAL] [PII], and yours?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] All right, that that was all I needed thank you so much, [PII].
[AGENT][POSITIVE] Well, you're very welcome, and if that is all I can help with, thank you again for calling APL, and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] I hope you too as well bye bye.
[AGENT][POSITIVE] Uh thank you very much bye bye.