AccountId: 011433970860
ContactId: 907fcc1e-5513-42da-b059-cf1822c5842f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232750 ms
Total Talk Time (AGENT): 109147 ms
Total Talk Time (CUSTOMER): 89428 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/907fcc1e-5513-42da-b059-cf1822c5842f_20250306T19:37_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] from the doctor's office. I have a patient. I want to confirm eligibility and benefits for specialist office visit. Can you please assist me?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the um benefits for a specialist office visit and the eligibility. And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes. The uh contact number is [PII] direct line. And the policy number is, it's 023-08242 M like Mary L like Lima 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, of course. The member's name is [PII] and date of birth is, it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII]. And for the specialist visit, so for the
[AGENT][NEUTRAL] Place of service or the facility charge, there's no coverage, but the insured does have the office treatment rider. So any treatment that's done in the office as long as it's not cosmetic, could be covered up to the calendar year max of $6600.
[AGENT][NEUTRAL] Did you want me to see if any of the calendar year max has been used?
[CUSTOMER][POSITIVE] Yes, of course, also provide me the accumulation that that.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And um none of the benefits have been used for 2025, so she still has the full 6600.
[CUSTOMER][NEUTRAL] OK. And this is the secondary insurance for the patient, am I correct?
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Hold on one moment. Yes, this is secondary.
[CUSTOMER][NEUTRAL] OK. And I also want to know that uh if primary, uh, like the BCBS is primary uh left or remains some uh responsibility from the claim, uh like uh co-pay, deductibles and co-insurance are also uh covered the secondary insurance as well?
[AGENT][NEUTRAL] You said if there's a leftover of the 3 from primary after they've already applied, will secondary apply?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, exactly, remaining amount from the primary.
[AGENT][NEUTRAL] Yes, as long as it's a covered charge on the policy because the secondary policy has its own its own benefits. So as long as it's a covered charge, yes, we do pay towards those three.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, OK. Means uh co-pay, deductibles and co-insurance uh are all are covered. OK. Thank you so much. Uh, also confirming the electronic pay ID for claim submission as well.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. And uh, also give me the mailing address.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. Please give me the call reference number kindly.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date, and again, that's [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII], for providing me that useful information. Thank you so much. Have a nice day. Take care.
[AGENT][POSITIVE] You also, [PII] and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Take care.