AccountId: 011433970860
ContactId: 8f13858d-a82e-434c-8d2d-4c9212abb540
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482260 ms
Total Talk Time (AGENT): 182606 ms
Total Talk Time (CUSTOMER): 181700 ms
Interruptions: 2
Overall Sentiment: AGENT=1.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/8f13858d-a82e-434c-8d2d-4c9212abb540_20250325T13:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling on behalf of doctor's office to verify pre-certification requirements for secondary insurance.
[AGENT][NEUTRAL] OK, you're wanting to see if prequalification is required. Is that correct?
[CUSTOMER][NEGATIVE] Please be advised for this.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Yes, yes, please be advised that this call is recorded for quality and monitoring purposes. Could you please spell out your name for me?
[AGENT][NEUTRAL] [PII] and yours?
[CUSTOMER][NEUTRAL] [PII], and initial of my last name is [PII]. Could you please provide your initial, please?
[AGENT][NEUTRAL] [PII], what is your callback number?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] And the member's policy number is 01986419.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do any information that I do excuse me, provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so first off, she was this policy, but this policy is no longer active.
[AGENT][NEUTRAL] She does have another policy that is active, and I can provide that information.
[AGENT][NEUTRAL] But this policy number that you gave me termed as of [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK. Will you please provide me the start date of the policy?
[AGENT][NEUTRAL] He
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] [PII]. And uh lastly term date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And uh another policy ID?
[AGENT][NEUTRAL] The new policy number ID is 256.
[AGENT][NEUTRAL] 6507.
[AGENT][NEUTRAL] It is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] With no term date.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because this
[CUSTOMER][NEUTRAL] And the new ID number is
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, please go.
[AGENT][NEUTRAL] No, I, you can repeat it to me.
[CUSTOMER][NEUTRAL] And the new ID number is
[CUSTOMER][NEUTRAL] Yes, new ID is 256.
[CUSTOMER][NEUTRAL] 6507, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and because this is a supplemental policy to her primary insurance.
[AGENT][NEUTRAL] There is no prior authorization record.
[AGENT][NEUTRAL] When the claim is submitted to APO for review though Med who, yeah.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] You will need to also send us a copy of the primary explanation.
[CUSTOMER][NEUTRAL] OK. Thank you. Could you please provide me for
[AGENT][NEUTRAL] Yes, sir, but I'm needing to give you some additional information.
[CUSTOMER][NEUTRAL] OK. OK, please.
[AGENT][NEUTRAL] So again, when the claim is submitted to APL for redeem.
[AGENT][NEUTRAL] You will also need to send us a copy of her primary insurance company's explanation of benefits along with the claim.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you may check claim status in for APL by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that that I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well then, thank you.
[CUSTOMER][NEUTRAL] Could you please provide me call the number?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can I include the time in the reference number, [PII]?
[AGENT][NEUTRAL] The re
[AGENT][NEUTRAL] As I stated, the reference number is my name and today's.
[CUSTOMER][NEUTRAL] Today's date. OK.
[CUSTOMER][NEUTRAL] OK. Thank you. Before disconnecting the call, I'll summarize the information you provided me, [PII].
[AGENT][NEUTRAL] Well, you
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEGATIVE] Your, your voice is not.
[AGENT][NEUTRAL] I'm listening.
[CUSTOMER][NEUTRAL] Audible. OK. For the member [PII].
[AGENT][NEUTRAL] I'm sorry, uh, I'm sorry, I don't, it's, it's the phone.
[CUSTOMER][NEUTRAL] For the member [PII], [PII] and
[CUSTOMER][NEUTRAL] And the member ID 01986419 has, is no longer active and the start date of the policy is [PII] and the date is [PII]. And there is another active policy with you with the ID 2566507 and the start date of the policy is [PII] with no termination date.
[CUSTOMER][NEUTRAL] As it is a secondary insurance, no authorization is required for the procedure code and your name is [PII] S and the call reference number is TracyS 325 2025, right?
[AGENT][NEUTRAL] Yes, but you also did not include the fact that we must also receive a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] Along with the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then our portal website to check claim status is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we must also send a copy of primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you, [PII], for assisting me. Have a great day.
[AGENT][POSITIVE] Well, you're very welcome, so that, that is all I can help you with today. Is that correct?
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][POSITIVE] OK, well then thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][POSITIVE] OK. Thank you, thank you and wish you the same.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Bye, bye for now.
[AGENT][POSITIVE] Uh-huh, thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.