AccountId: 011433970860
ContactId: 87a178c4-d2f2-4128-8877-b16b4c2e0347
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313149 ms
Total Talk Time (AGENT): 123715 ms
Total Talk Time (CUSTOMER): 124050 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/87a178c4-d2f2-4128-8877-b16b4c2e0347_20250416T18:52_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] Hi [PII], this is [PII]. I'm calling in to check on eligibility status.
[AGENT][NEUTRAL] OK [PII], you're needing to check eligibility only for one member, is that correct?
[CUSTOMER][NEUTRAL] Yeah crazy.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Uh just a minute.
[CUSTOMER][NEGATIVE] Sorry for the delay, my system's froze. uh, it's 702.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the patient's policy number? Yes.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh, policy number is 018.
[CUSTOMER][NEUTRAL] 952.
[CUSTOMER][NEUTRAL] 52 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK, thank you one moment while I pull up the member's information please.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and might be any information that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII], and her date of birth is on, uh, [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the subscriber on the supplemental policy and the supplemental policy is active.
[AGENT][NEUTRAL] What's an effective date of [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said you needed eligibility?
[CUSTOMER][NEUTRAL] Uh, sorry.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, sorry, but your voice just, uh, went in and out. Can you please read me the eligibility status of that patient?
[CUSTOMER][NEUTRAL] Hello [PII].
[AGENT][NEUTRAL] Are you still there? [PII], are you there?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, I'm still here but yeah yeah uh can you hear me?
[AGENT][NEUTRAL] Uh, yes, I can hear you now.
[CUSTOMER][NEUTRAL] Uh, sorry, your voice just, you know, went in and out. I wasn't able to hear any benefits information. Uh, may I know when was the policy active?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I provided OK.
[AGENT][NEUTRAL] Yes, the effective date is [PII] and it is still active. This is a supplemental policy to the.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Still active.
[CUSTOMER][NEUTRAL] Mm mhm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] Yeah, so it's a supplemental policy and it's active from [PII], uh, so the patient has some medical coverage for this, right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] This is a supplemental medical policy to their primary health care insurance.
[AGENT][NEUTRAL] So when the claim is, yes.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][NEUTRAL] And if you all will be filing a claim with APO for this member, we must also receive a copy of the primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, uh, [PII], we have, uh, AV made that's the primary policy for that member, and we have received a payment. I mean, it was processed to its deductible, uh, so patient contacted us and, uh, asked us to file it to the secondary insurance. We are just confirming if the policy was active. Thank you so much for that. So, uh, we'll go ahead and, uh, file.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and then once we have processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're gonna be filing the claim to APL and once it has been filed and processed, we have a portal that you should be able to check claim status in, and that website, Matthew is secured. [PII]. And again, just make sure to send the primary insurance company's explanation of benefits along with the claim for our review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure, [PII], thank you so much and we'll do the same. Can I have a call reference number on this one?
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][NEUTRAL] Yes, sir, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, it's [PII] and today's date. Thank you so much, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] Yes, sir. You're welcome. And I hope you have a great afternoon too. And if that's all I can help you with, then thank you again, [PII], for calling APL.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye-bye.