AccountId: 011433970860
ContactId: a1d03ee5-8687-4891-a626-2461aa5be75d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287720 ms
Total Talk Time (AGENT): 135429 ms
Total Talk Time (CUSTOMER): 124452 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/a1d03ee5-8687-4891-a626-2461aa5be75d_20250502T15:36_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, hi. Uh, my name is [PII] and I'm from provider's office. I have one patient. I'm just looking for benefits.
[AGENT][NEUTRAL] OK, I can verify benefits for you and [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] OK. So, it's 02581461.
[CUSTOMER][NEUTRAL] M for [PII] [PII] 8.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][POSITIVE] Thank you and do you have a.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], you say you're calling to verify benefits and eligibility for this patient, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII], policy is active. And what benefits are you needing?
[CUSTOMER][NEUTRAL] All right. So, first of all, could you please check that the provider is in-network with this policy or not?
[AGENT][NEUTRAL] Uh, we don't have a network with this policy. It's a secondary supplemental plan, so it depends on if you're a network with their major medical.
[CUSTOMER][NEUTRAL] Uh, we don't have it at work but if it's something.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. So what's the plan of this policy?
[AGENT][NEUTRAL] It's a secondary supplemental policy.
[CUSTOMER][NEUTRAL] It's a 2nd
[CUSTOMER][NEUTRAL] OK. Uh, is there any co-pay applied?
[AGENT][NEUTRAL] No, there's no co-pay under the plan, but what benefits are you needing?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] All right. So, I have one CPT code.
[CUSTOMER][NEUTRAL] It's J as in Juliet 9041. It's for chemotherapy.
[AGENT][NEUTRAL] OK, and is this gonna be performed in an outpatient facility or a doctor's office?
[CUSTOMER][NEUTRAL] OK, and is this gonna be performed in an outpatient facility or?
[CUSTOMER][NEUTRAL] An outpatient facility.
[AGENT][NEUTRAL] OK, uh, not a guarantee of payment, just a verification of coverage, but this policy is secondary, as I stated, we help with primary insurance deductible, co-pay and or co-insurance, and the insured has a benefit max of up to $250 per calendar day.
[CUSTOMER][NEUTRAL] OK, but sorry, but I didn't get it. Could you please repeat one more time?
[AGENT][NEUTRAL] Uh, with this policy as secondary, we help with primary insurance deductible, co-pay and co-insurance, not a guarantee of payment, just a verification of coverage. The insured has a benefit max of up to $250 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So, basically, this policy covers uh primary co-payductible out of pocket.
[AGENT][NEUTRAL] We pick up what they apply towards deductible, co-pay or co-insurance. So after a major medical has processed the claim, if they applied any amounts towards deductible, co-pay or co-insurance, that's what we pick up and pay is secondary up to that $250 per calendar day.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so uh $250 is the maximum amount, right, for this uh calendar year.
[AGENT][POSITIVE] Correct, per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 04 party, got it.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] OK, that's all. Thank you so much for providing this information. And yeah, by the way, could you provide me the claim address for this one?
[AGENT][NEUTRAL] Uh, mail address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, after the [PII], could you please repeat?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, got it. Thank you so much. And what's your first name and last name, [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, first name is [PII], last initial [PII]. And [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, no, that's all. Just if there any reference number then please let me know.
[AGENT][NEUTRAL] Uh, you can use my name in today's date if you like.
[CUSTOMER][POSITIVE] OK, no problem. OK, that's all. Thank you so much for providing this information. Have a great day. Bye.
[AGENT][POSITIVE] Alright, you're welcome. You too, thanks for calling APL bye.
[CUSTOMER][NEUTRAL] Bye.