AccountId: 011433970860
ContactId: 9005e908-c04f-472f-9155-14107c4c0287
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246449 ms
Total Talk Time (AGENT): 125625 ms
Total Talk Time (CUSTOMER): 55928 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/9005e908-c04f-472f-9155-14107c4c0287_20250205T19:51_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] Hey [PII], I wanted to um get a member's benefit information, see what kind of plans this is.
[AGENT][NEUTRAL] OK. You, do you also need eligibility or only benefits?
[CUSTOMER][POSITIVE] Yeah, I'll take eligibility too thank you.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII] and that's [PII] Last initial is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 01758742
[AGENT][POSITIVE] OK, [PII], thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] What the heck
[AGENT][NEUTRAL] And [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is gonna be [PII], date of birth of [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is a supplemental policy to her primary insurance. It's designed to help with her co-pays, deductibles and co-insurance amounts of coverage services.
[AGENT][NEUTRAL] So what type of benefit information are you needing? inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this supplemental policy, she has an outpatient benefit maximum of $1000 per calendar year per covered person for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And because this is a supplemental policy, when you submit the claim to APO we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you should be able to check claim status in and our portal website is secured. [PII].
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] And is there any accumulation to that 1000 per year yet?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] As of now, no there is not, we do not have any claims on file for her.
[CUSTOMER][NEUTRAL] OK, and then do you guys participate in a network or is it like an open? OK.
[AGENT][NEUTRAL] We do not.
[AGENT][NEUTRAL] Yes, this we would follow the primary insurance and anything not covered by her primary would also not be covered by APO.
[CUSTOMER][POSITIVE] Got it OK.
[CUSTOMER][POSITIVE] Awesome well thank you [PII]. Is there a call reference number I can have?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and if you need the first initials of my last name, [PII], it's [PII].
[CUSTOMER][POSITIVE] Perfect thanks so much, [PII].
[AGENT][POSITIVE] You're welcome and thank you again for calling APL. I hope you have a great evening.
[CUSTOMER][NEUTRAL] You too now bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.