AccountId: 011433970860
ContactId: 951b9b08-6d71-4a35-a586-ba72bd9b18ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295390 ms
Total Talk Time (AGENT): 156496 ms
Total Talk Time (CUSTOMER): 95423 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/951b9b08-6d71-4a35-a586-ba72bd9b18ba_20250311T12:33_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]. I'm calling to verify coverage on a patient.
[AGENT][NEUTRAL] OK, are you needing to verify eligibility and benefits, both?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from Catawba Valley Healthcare, also known as the Mental Health fund.
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] 02284090.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Embedding any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Um, patient's name is [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that she is the the spouse of the subscriber on the supplemental policy, and this supplemental policy, [PII] is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Office
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK, can I ask you a quick question, um, [PII], um, this is a supplement to her Blue Cross Blue Shield, am I correct?
[AGENT][NEUTRAL] Mhm. Sure.
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] So, OK, so you guys want a secondary insurance, OK.
[AGENT][NEUTRAL] That is correct. Mhm. We are not a major medical insurance company. It is a supplemental policy only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That helps her with co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, um
[CUSTOMER][NEUTRAL] Another question is that I have American public life insurance. Do you guys have under another umbrella that we can?
[AGENT][NEUTRAL] No, ma'am. That is, that is the name of the company.
[CUSTOMER][NEUTRAL] OK, now
[CUSTOMER][NEUTRAL] And what is your EDI number?
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] To submit claims.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, now you go ahead and continue.
[AGENT][NEUTRAL] So no, you're fine. I'll be happy to answer any questions I can for you. OK, so on this supplemental policy, her um outpatient office benefit is $25 per visit and a maximum of 4 visits per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How is it
[CUSTOMER][NEUTRAL] Now, would she still have to, even though she has Blue Cross Blue Shield Primary, she'll still have to pay that $25 copay.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, it's, that's not a co-pay, that's the benefit on this policy if approved. That is what this policy would pay.
[CUSTOMER][POSITIVE] OK, I'm so sorry. Oh yeah.
[AGENT][NEUTRAL] Towards an office visit, that's OK. So when a claim is submitted with this type of policy, [PII], we will have to have a copy of our primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once the claim has been processed by us we do also have a portal that you should be able to check claim status in and our portal website for that excuse me is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, got it.
[CUSTOMER][NEUTRAL] And the address for the claims is the [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Well, it should be [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes ma'am, uh huh, that's correct.
[CUSTOMER][POSITIVE] Alright, perfect.
[AGENT][NEUTRAL] And then I think that's, do you have any other questions?
[CUSTOMER][POSITIVE] Alright [PII] thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] No ma'am, I am good.
[AGENT][POSITIVE] OK, well then, [PII], thank you again for calling APL and I hope that you have a very nice day today.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you very much.
[CUSTOMER][POSITIVE] You're welcome bye bye.
[AGENT][NEUTRAL] Bye-bye.