AccountId: 011433970860
ContactId: 82e56398-ce57-4b08-b3b0-560a9edc6556
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 184779 ms
Total Talk Time (AGENT): 129357 ms
Total Talk Time (CUSTOMER): 76028 ms
Interruptions: 5
Overall Sentiment: AGENT=1.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/82e56398-ce57-4b08-b3b0-560a9edc6556_20250103T18:34_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Doctor [PII]'s office. I have a patient that's coming in to do an in-off procedure, and I just wanna know if you guys pick up her deductible or is it just for hospital.
[AGENT][NEUTRAL] OK, so you're needing to get benefit information on a member, is that correct, [PII]? Yes ma'am, I can help you with that. And what is your callback number please?
[CUSTOMER][POSITIVE] Yes, please. Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, it's 01755355 M as in Mary, L as in Larry 8.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] What is her date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the spouse of the subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] On this policy, she does have an office treatment writer. Now office visits are not covered, let's say she does have a treatment writer they can be reviewed under her outpatient benefit and that maximum is $200 per covered person per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For covered outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Medicaid, so yeah.
[AGENT][NEUTRAL] And then there is no outpatient deductible per cover person per calendar day.
[CUSTOMER][NEUTRAL] OK, so she gets she gets a $200 that you guys will put towards whatever she needs to pay.
[AGENT][NEUTRAL] Again, I can't guarantee payment. We will have to receive the the claim and the and the primary EOB to review uh for benefits, but that is the maximum amount that we would pay for our coverage service, uh huh, per calendar day.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, and that's and that's per day she doesn't have, yeah, she doesn't have a max like per year of what she can use or no?
[AGENT][NEUTRAL] Not on this, on this supplemental policy, they have a daily.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alright [PII] thank you so much I appreciate all your help.
[AGENT][POSITIVE] Calendar year. You're welcome.
[AGENT][NEUTRAL] OK [PII], you're very welcome. And just two additional things right quick, make sure um that the primary EOB comes with the claim for our review because we do have to have that. And then once we have processed our claim, we do have a portal if you've not already been given that before, um, called the online service center where you should be able to check claim status and also print EOBs for APL and that website that you would go to to set up that.
[CUSTOMER][NEUTRAL] Yeah, yeah, go right ahead.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh huh.
[CUSTOMER][POSITIVE] OK, OK, all right, [PII] thank you so much I appreciate it.
[AGENT][POSITIVE] OK. Well, you, um, yes, ma'am, it was my pleasure and I hope you have a wonderful weekend and thank you again for calling APL.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] You too. Thank you so much.
[AGENT][POSITIVE] All right, [PII]. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] OK bye bye.