AccountId: 011433970860
ContactId: 9a176d54-55bd-4c6c-b6d0-3d637a7383d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287839 ms
Total Talk Time (AGENT): 146890 ms
Total Talk Time (CUSTOMER): 61780 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/9a176d54-55bd-4c6c-b6d0-3d637a7383d5_20250227T19:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from a doctor's office to get the benefits and eligibility and also to see if you pick up anything from the patient's primary.
[AGENT][NEUTRAL] OK, so you're needing benefits and eligibility for a member, is that correct?
[CUSTOMER][POSITIVE] Yeah, yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It's [PII] sorry.
[AGENT][NEUTRAL] Oh, it's OK.
[CUSTOMER][NEUTRAL] My extension is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you? Um, no, the member's policy number. Goodness.
[CUSTOMER][NEUTRAL] It is, it's OK 02369605 ML 8.
[AGENT][NEUTRAL] OK, thank you. One moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I can do on any information that I do provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have it to be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's for the office specialist.
[AGENT][NEUTRAL] OK, for an office visit. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so on this policy, office visits are not covered.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if he were to receive some type of treatment within the office, there is an office treatment writer on here that we could review under the outpatient benefit maximum, but an office visit is not covered.
[CUSTOMER][NEUTRAL] OK, he's.
[CUSTOMER][NEUTRAL] OK, he's here for a vasectomy.
[AGENT][NEUTRAL] OK, so his outpatient benefit on this policy, just give me one moment.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Per person for covered outpatient services is $2500. And again, that is.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Her occurrence.
[CUSTOMER][NEUTRAL] OK, and has he used any of that as of today?
[AGENT][NEUTRAL] No ma'am, as of now he has not and because this is a supplemental policy to his primary insurance, when the claim is submitted to APL, you also will need to include a copy of his primary insurance company's explanation of benefits as well. And then once we have processed our claims you have there, we do have the portal that you should be able to check claim status in and also access our EOB.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] And our portal website for that is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK, and is there a reference number for this call, please?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much Ms. [PII].
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that is all I can help you with, thank you again, [PII], for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.