AccountId: 011433970860
ContactId: 930ff8d6-0e60-41de-8e76-68b89f934530
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232399 ms
Total Talk Time (AGENT): 113404 ms
Total Talk Time (CUSTOMER): 94662 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/930ff8d6-0e60-41de-8e76-68b89f934530_20250305T16:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. Uh, my name is [PII]. I'm actually calling from Autobox Orthopedic Services. We have, uh, a member, well, a patient rather who have your insurance, and we were trying to find out if some eligibility and benefits and actually if we're in network with this plan. We never heard of this one before.
[AGENT][NEUTRAL] Sure, of course, yeah, I can check eligibility and benefits and what network that might be a part of, uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that is [PII] and that's no extension.
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. I have 02117282.
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] So, it's for [PII]. The last name is [PII] and that is um [PII].
[AGENT][POSITIVE] Perfect. OK, thank you so much for verifying that information, [PII]. Uh, so this policy is active.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Effective date was [PII] for this number.
[AGENT][NEUTRAL] And then let's take a look here. So this is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[AGENT][NEUTRAL] And we needed to look at the outpatient benefit?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, I'm trying to verify we're in network with you guys.
[AGENT][NEUTRAL] Sure, so this policy doesn't operate on a network like that. It's very dependent on major medical. So as long as major medical is willing to pay this policy can if major medical does not, this policy can't.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So when you say major medical, is that um like their primary anthem insurance?
[AGENT][NEUTRAL] Right, whoever they've got as their primary, yeah, Aetna Blue Cross, Cigna.
[CUSTOMER][NEUTRAL] OK, alright, so let me.
[CUSTOMER][NEUTRAL] Now, do you guys have a payer ID number like to where we would submit a claim to?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Absolutely let me know when you're ready for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I am ready.
[AGENT][NEUTRAL] OK, it is 60801.
[CUSTOMER][NEUTRAL] 60801. So I just want to verify, so the plan is active, this is a major medical, a secondary major medical plan. So you guys pay if the primary pays pretty much. So like they don't have a deductible or anything, you guys cover 100% of what is left over from the primary insurance.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, um, so it does help with a co-pay deductible and co-insurance after major medical, but it does have a benefit limit on inpatient and outpatient benefits, um, and I can give you those amounts, um, but of course I will let you know verification of coverage is not a guarantee of payment for claims, so for each inpatient and outpatient benefit, um, the maximum benefit amount is $8100 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Have they met any of that yet? Does it show you?
[AGENT][NEUTRAL] Sure, let me check that. Give me just a moment.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I'm not showing that any of that has been used before this year.
[CUSTOMER][NEUTRAL] Alright, and I'm sorry, could you spell your first name out for me?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] And can I just have the first initial of your last name, please?
[AGENT][NEUTRAL] Yeah, it's [PII] and was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'm just gonna say, do you have a call reference number or is this your call reference number?
[AGENT][NEUTRAL] Uh, it would just be my first name, last initial, and today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. You enjoy the rest of your day.
[AGENT][POSITIVE] Of course, yes, thanks for calling APL. You too, bye bye.
[CUSTOMER][POSITIVE] Thanks bye bye.