AccountId: 011433970860
ContactId: 9239fb93-e360-4581-b772-81e4307ae769
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 357420 ms
Total Talk Time (AGENT): 201560 ms
Total Talk Time (CUSTOMER): 137139 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/9239fb93-e360-4581-b772-81e4307ae769_20241231T13:05_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] Good morning, [PII]. This is [PII] calling from Absolute dermatology. How are you doing?
[AGENT][NEUTRAL] I'm fine, but I'm so sorry I did not catch your name. Could you give me your name again?
[CUSTOMER][NEUTRAL] For sure. This is [PII]. My name is spelled as [PII]
[AGENT][POSITIVE] OK, Re. Thank you. And how can I help you today?
[CUSTOMER][NEUTRAL] Perfect. Um, [PII], I have a patient, Mr. [PII], and I just, I mean, he gave us the information that he's a secondary with us. I just wanted to confirm that we are in network with, um, you guys, so there are providers in network because he had a surgery. I just wanted to confirm if that would be covered or does it apply to his deductibles or what are his surgical benefits in general.
[AGENT][NEUTRAL] OK, so you need.
[AGENT][NEUTRAL] OK, so you need to get eligibility and also benefit information, is that correct?
[CUSTOMER][POSITIVE] Benefits. Uh-huh. That's correct. Uh-huh.
[AGENT][POSITIVE] Yes, I can, yes, I can help you with that. And first off, what is a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] This is going to be [PII]. And that's my direct line.
[AGENT][NEUTRAL] OK, thank you. And then also, what is the member's policy number, please?
[CUSTOMER][NEUTRAL] So the member's policy is, give me one quick second, this is 0202444783.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Now, that is gonna be too many numbers for Ame his insurance is with American Public Life.
[CUSTOMER][NEUTRAL] OK, so this is, I'm gonna repeat that to you. 02444783.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so yes, there were, there was an extra 0202 with the first one you gave me. OK, so.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] 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] Sure, this is for [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So on this policy, he is the subscriber and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And this is a supplemental policy to his primary insurance company. Um, this is, this policy is designed to help him with co-pays, deductibles and co-insurance amounts of covered services. So for this policy there is no network, it would follow their primary. There's not any network with APL.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK, so, um, just to confirm that I follow this, so if we are in network with his primary, that means we would be in network with the APO, is that right?
[AGENT][NEUTRAL] Correct, essentially, yes, because there is no network with this policy.
[CUSTOMER][NEUTRAL] Mm, OK, no network with this policy.
[CUSTOMER][POSITIVE] Perfect. And I think that will be it. Do you need any sort of provider information or anything?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Now, ma'am, do you need any benefit information? Was this for inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] This was for in, this was for outpatient in the office surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so he does have an office treatment writer on this policy?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it that can be reviewed under his outpatient benefit maximum which is $3000 per covered person per calendar year for covered outpatient services and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] When the claim is submitted to APO for us to review it, we will have to have a copy of his primary insurance company's explanation of benefits as well for review.
[AGENT][NEUTRAL] And once we process the claim here you can set up a profile in our portal. Our portal is called the online service center.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And that website that you would do that is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] Again, that is secured.
[CUSTOMER][NEUTRAL] And what do we need this email for?
[AGENT][NEUTRAL] That is not an email. That's a website secured. uh-huh, that's for our portal that you can create a username and password to have access to the EOB with for APL once we have processed the claim.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Oh, OK, get it.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, perfect. Perfect. I think that would be all, [PII]. Can I please have a call reference number?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] And your name is spelled as [PII]?
[AGENT][NEUTRAL] No, [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. [PII] Perfect. And that will be 1231-2024. Perfect. [PII], thank you so much. I hope you have a great day and anything else you need from my side?
[AGENT][NEUTRAL] Yes, ma'am. We.
[AGENT][POSITIVE] Uh, no, that is, I don't need anything else from, from you. And if, um, that's all I can help you with, I hope you have a great day too, and a very happy New Year.
[CUSTOMER][POSITIVE] Happy New Year, [PII]. Take care. Bye-bye.
[AGENT][POSITIVE] Thank you. Yes, ma'am. Bye-bye.