AccountId: 011433970860
ContactId: 83da9875-4e1c-42c1-927f-86af15da0643
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366170 ms
Total Talk Time (AGENT): 158612 ms
Total Talk Time (CUSTOMER): 122441 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/83da9875-4e1c-42c1-927f-86af15da0643_20250310T18:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon [PII]. My name is [PII]. I'm calling from a provider office. I just wanted to check a benefit for a patient, please.
[AGENT][NEUTRAL] OK, you're needing to check benefits only. You do not need eligibility, is that correct?
[CUSTOMER][NEUTRAL] Well, both if it's possible, please, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I can help you with that and could you please spell your first name for me?
[CUSTOMER][NEUTRAL] Of course it's [PII].
[AGENT][POSITIVE] Thank you. OK, thank you, [PII], and your callback number, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] It would be um one second here it is 02064016.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you. So yes, ma'am, that I can help you with eligibility and benefits. Give me just a moment please. Let me to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No worries go ahead.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] So it's for, it's uh you know um it's for two people I guess they're in the same plan Mr. and Mrs. um, they're different last name though, um, so the I guess the main one would be her name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] And her husband was.
[AGENT][NEUTRAL] And the other member?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so yes, she is the subscriber on the supplemental policy and he is the spouse and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need on this supplemental policy, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, outpatient office, yes, um, we are a specialist like an ophthalmologist office, so, um, I just wanted to know if their copays and deductibles are covered by the secondary or.
[CUSTOMER][NEUTRAL] Because they're stating that the the copay should be applied to you guys, so I just wanna make sure.
[AGENT][NEUTRAL] OK, so give me just one moment please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let me pull the benefit information up on this one.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so on this supplemental policy, there is um a $25 per visit benefit with a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] They are subject to their co-pay then.
[CUSTOMER][NEUTRAL] you
[AGENT][NEUTRAL] This policy is designed to help with their co-pays, deductibles, and co-insurance amounts of coverage services. So when the claim is submitted to APO for reviews the limit, you do all have to, excuse me, you would have to send us a copy of their primary insurance company's explanation of benefits. But for an office visit or treatment in the office, yes, the benefit on this plan is $25 per visit at a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, because, um, yes, we do have that they have their primary insurance as UMR with United and there I mean it is also a 25 copay, so is it an additional 25 that they have to pay with you guys?
[AGENT][NEUTRAL] No, ma'am, I'm telling, that's what our benefit is. We're not a major medical carrier. That would be the benefit on this policy, not what they pay. That would be the maximum that we would pay would be $25.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, the max that you ordered will be the 20, got it. OK, so that's OK.
[AGENT][NEUTRAL] That's the benefit. Mhm.
[CUSTOMER][NEUTRAL] Got it. OK, um, do you by any chance provide a reference number, [PII] for this call?
[AGENT][NEUTRAL] Sure, you, you would use my name along with today's date and then [PII], one last thing if you all do file a claim with us, as I stated, you know, you would need to send us a copy of the primary insurance company's explanation of benefits as well. And then once we have processed the claim, we do have a portal in which you could check claim status for us and have access to our EOB and that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Website for our portal is [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and just to confirm, the claim is the [PII] 248,950 for you guys?
[AGENT][NEUTRAL] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] We
[CUSTOMER][POSITIVE] OK perfect OK thank you [PII] that's all I needed to know thank you so much for all your help.
[AGENT][POSITIVE] Well, you're absolutely, you're very welcome. So if that is all I can help you with, thank you again for calling [PII]. I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] You too take care bye bye.
[AGENT][NEUTRAL] Bye-bye.