AccountId: 011433970860
ContactId: 91c8759f-b872-41f7-8545-3baef9cf7865
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286200 ms
Total Talk Time (AGENT): 139596 ms
Total Talk Time (CUSTOMER): 67180 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/91c8759f-b872-41f7-8545-3baef9cf7865_20250212T21:45_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, what's the first initial of your last name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you, I'm calling for benefits on a patient.
[AGENT][NEUTRAL] OK, you're needing benefits. Do you also need eligibility?
[CUSTOMER][NEUTRAL] Please
[AGENT][POSITIVE] Yes, I can help you with both. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And your first initial to your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. And your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, [PII]. I'm I'm so sorry. Can you start over? I was having trouble hearing you.
[CUSTOMER][NEUTRAL] It's OK, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Extension [PII].
[AGENT][NEUTRAL] Thank you. And what is your patient's policy number?
[CUSTOMER][NEUTRAL] It is 02443500 ML 8.
[AGENT][NEUTRAL] OK, thank you. Give me one moment. I need to get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today would be a verification of benefits, excuse me, and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do show that he is a dependent on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him, [PII] inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Patient?
[CUSTOMER][NEUTRAL] Outpatient, they're coming in for an outpatient hospital CT scan?
[AGENT][NEUTRAL] OK, the outpatient benefit max per calendar year for covered outpatient services per person is $6000.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] And has anything been used?
[AGENT][NEUTRAL] I can check that for you, one moment.
[AGENT][NEUTRAL] For this calendar year, yes, he has used $18.57 as of now.
[CUSTOMER][NEUTRAL] OK perfect and then do they have a group name or group number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. The group number is 23755.
[AGENT][NEUTRAL] And the name of the group is Integra Solutions LLC.
[CUSTOMER][NEUTRAL] OK, perfect. And then you said that $8000 I'm sorry, the $6000 is per person per calendar year, right?
[AGENT][NEUTRAL] And because
[AGENT][NEUTRAL] For covered outpatient services, yes, ma'am.
[AGENT][NEUTRAL] With no outpatient deductible.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK, um, and no authorization is required, correct?
[AGENT][NEUTRAL] That is correct. Now, because this is a supplemental policy, we must also receive a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim and we have a portal that you should be able to check claim status in and have access to our EOB by going to secured. [PII].
[CUSTOMER][NEUTRAL] Can I have your PO claims address is [PII].
[CUSTOMER][NEUTRAL] And then [PII]?
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] 950.
[CUSTOMER][POSITIVE] OK perfect thank you so much you guys don't get reference numbers, right?
[AGENT][NEUTRAL] Well you
[AGENT][NEUTRAL] Right. Well you, you would use my name along with today's date?
[CUSTOMER][POSITIVE] Thank you so much. Have a great day.
[AGENT][POSITIVE] Yes ma'am, you too, if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.