AccountId: 011433970860
ContactId: 8a102f7a-3d9b-406f-86d4-ca18926688c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352239 ms
Total Talk Time (AGENT): 169150 ms
Total Talk Time (CUSTOMER): 123864 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/8a102f7a-3d9b-406f-86d4-ca18926688c7_20250310T18:24_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, I'm calling from our provider's office because um I have a patient that is telling us that we need to send a claim over to this insurance and I just wanted to verify that that's what we're supposed to do.
[AGENT][NEUTRAL] OK, so you're wanting to verify a member's eligibility? Is that correct?
[CUSTOMER][NEUTRAL] Yes, and to and to see if we bill this after their primary insurance.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] I'm so [PII].
[AGENT][NEUTRAL] Could you start over your voice completely cut out on the area code?
[CUSTOMER][NEUTRAL] 508.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 8909957
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02503253G
[AGENT][NEUTRAL] Mm, I don't know what the G is.
[AGENT][NEUTRAL] OK, so give me just because we don't have, we don't have letters like that on our, so give me just one moment.
[AGENT][NEUTRAL] OK, so first off, any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so for us, yes, there is no G on the end of that number, OK, [PII], and I do show that he is a subscriber on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, so we can send over claims after the primary insurance pays.
[AGENT][NEUTRAL] Yes, you would not send them before because you will also have to include a detailed explanation of benefits from the primary.
[AGENT][NEUTRAL] For us to be able to see the co-pays, deductibles, or co-insurance amounts because this policy is designed to help with those three categories of covered services.
[AGENT][NEUTRAL] Now, what type of
[CUSTOMER][NEUTRAL] OK, and.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Paper paper the paper mailing address is [PII].
[AGENT][POSITIVE] That is correct. Yes, ma'am. Now, on this policy,
[CUSTOMER][NEUTRAL] OK, and.
[AGENT][NEUTRAL] Uh huh, no, go ahead with your question.
[CUSTOMER][NEUTRAL] And she they provided me with a group number um or group numbers used.
[AGENT][NEUTRAL] Yes, 23433.
[CUSTOMER][NEUTRAL] And then she gave me a whole bunch more numbers. Do I stop at the 433?
[AGENT][NEUTRAL] I wouldn't have a clue what those were.
[CUSTOMER][NEUTRAL] Oh and then the other one's her number.
[CUSTOMER][NEUTRAL] OK, no, I see. She gave me the 23433 and then her ID number again.
[AGENT][NEUTRAL] Oh, OK, so yes, ma'am, the, yeah, there's a policy number and then the the second, the 5 digit number is her group number.
[CUSTOMER][NEUTRAL] OK, so I see what happened.
[AGENT][NEUTRAL] Or his group number. You, you said she and I said he is Mr. [PII] group number.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Yes, I'm I'm sorry the spouse is the one that provided the information.
[AGENT][NEUTRAL] OK. Now, on this policy, OK, now, office visits are not covered under this policy, but we can review treatment rendered in the office.
[CUSTOMER][NEUTRAL] For him
[CUSTOMER][NEUTRAL] Um, no, I think they're just trying to use this insurance for their.
[CUSTOMER][NEUTRAL] Yeah, it was, um, I don't know it was just an established office visit, um.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so office visits are not covered.
[AGENT][NEUTRAL] Under the supplemental policy.
[CUSTOMER][NEUTRAL] Um, what about a
[CUSTOMER][NEUTRAL] Yeah, well, it does.
[CUSTOMER][NEUTRAL] Yeah, it does say an office visit but then um you know I don't know what they were seeing for.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I will, I will know that often.
[CUSTOMER][NEUTRAL] Not included in the policy.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, but if you are sending a claim in, yes ma'am, we will have to have a copy of the primary insurance explanation of benefits for review as well. And then once we have processed our claim, [PII], we have a portal that you should be able to check the claim status and have access to our EOB and the website for that is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, that's where I got your information.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Yes, perfect. Alright great then that's everything I needed thank you very much.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that is all I can help you with, thank you again for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you you too