AccountId: 011433970860
ContactId: 903cba4e-c54b-4637-ba18-9f5262e6cb76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388279 ms
Total Talk Time (AGENT): 171064 ms
Total Talk Time (CUSTOMER): 147279 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/903cba4e-c54b-4637-ba18-9f5262e6cb76_20250411T16:28_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] Yeah, hi [PII], this is [PII] initial letter of my last name. May I know yours?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I wanna know if pay is required um under patients plan.
[AGENT][NEUTRAL] OK, you're needing to find out if pre-certification is required on a member's plan, is that correct?
[CUSTOMER][NEUTRAL] I got iced coffee.
[CUSTOMER][POSITIVE] Uh-huh, correct.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that and [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[AGENT][NEUTRAL] [PII], did you say your extension is [PII]?
[CUSTOMER][NEUTRAL] Uh, sorry, yeah, [PII] correct.
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] All right. Patients policy number shows here is 02463395.
[AGENT][NEUTRAL] Thank you, one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. Do you also need eligibility or only pre-cert information?
[CUSTOMER][NEUTRAL] Um, eligibility, uh, sorry, benefits for a specific CPT code.
[AGENT][NEUTRAL] OK, so I can provide you general benefit information.
[AGENT][NEUTRAL] So this supplemental policy is active. She is the subscriber. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And again this is a supplemental policy to her primary insurance so there would not be any prior authorization or pre-cert required with APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] And then do you need.
[CUSTOMER][NEUTRAL] It follows um primary guidelines.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. So, for, for example, [PII], the uh primary insurance um requires prior authorization for a specific procedure. So, in this specific supplementary plan, it also requires prior authorization. Is it right?
[AGENT][NEUTRAL] So that would be
[AGENT][NEUTRAL] No, it does not. No, it would not under any circumstances require priors.
[CUSTOMER][NEUTRAL] Oh no, so this is also not required.
[AGENT][NEUTRAL] It is not required for the supplement. No, ma'am.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And are you needing inpatient, outpatient or office benefits for this number?
[CUSTOMER][POSITIVE] OK, OK, great.
[CUSTOMER][NEUTRAL] Outpatient, um, outpatient facility or hospital.
[AGENT][NEUTRAL] OK, so the outpatient.
[AGENT][NEUTRAL] OK, so the out patient benefit max on this policy per calendar year for covered outpatient services per person is $1000.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] No deductible, OK?
[AGENT][NEUTRAL] And because
[AGENT][NEUTRAL] And maximum benefit per calendar year for covered outpatient services is $1000.
[AGENT][NEUTRAL] Because this is a supplemental policy, [PII], when the claim is submitted to APL for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once the claim has been processed by APL we do have a portal in which you should be able to check claim status for us and our website for the portal is secured.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, [PII], I have some specific question here regarding the benefits or patients benefits. Is it OK?
[AGENT][POSITIVE] Uh yes, ma'am. I can try and help you.
[CUSTOMER][NEUTRAL] If, if it is not um up.
[CUSTOMER][NEUTRAL] Thank you. If it is not applicable, you can just say uh not applicable or no or zero, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. Uh, how about co-pay?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No copay, OK. Co-insurance is also not applicable.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Out of pocket?
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] Not applicable.
[CUSTOMER][NEUTRAL] No. And then, not applicable, OK. And then deductible is no, right?
[AGENT][NEUTRAL] Because we're not a major medical insurance company.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm, OK, OK, OK, great. I have the information that I need here, um, [PII], uh, what I need now is the uh call reference number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The reference number would be my name along with today's date.
[AGENT][NEUTRAL] And is there anything else, [PII] I can help you with?
[CUSTOMER][NEUTRAL] OK. [PII] S.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right. No, I'm good. Thank you for assisting me today, [PII]. Have a good and wonderful day ahead. Bye-bye for now.
[AGENT][POSITIVE] OK. Well, you, yes, ma'am. I hope you too and thank you for calling APL.
[AGENT][NEUTRAL] Bye-bye.