AccountId: 011433970860
ContactId: a2d2ade0-03a4-4037-b63a-268c952553ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323910 ms
Total Talk Time (AGENT): 124763 ms
Total Talk Time (CUSTOMER): 55879 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/a2d2ade0-03a4-4037-b63a-268c952553ba_20250527T19:00_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK, should I just cancel.
[CUSTOMER][NEUTRAL] Hi, good afternoon. Uh, my name is [PII]. I'm calling from Ortho now to verify if a patient's policy covers their primary's urgent care co-pay.
[AGENT][NEUTRAL] OK, you're needing to get eligibility and benefit information, is that correct, [PII]?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][POSITIVE] Yes, I can help you with that and what is a good call back number for you?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 02487978.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, call 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] Um, her name is [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show and again any information provided will be a verification of benefits and not a guarantee of payment. I do show that she is the subscriber on the supplemental policy and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And you said this is gonna be for urgent care that you're needing benefit information, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so on this plan, um, the maximum outpatient benefits.
[AGENT][NEUTRAL] Her calendar day is $4250.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] And for urgent care facility, it's a maximum of 3 urgent care visits for covered person per calendar year.
[CUSTOMER][NEUTRAL] OK. Um, would you be able to tell me if any of the visits have been used?
[AGENT][NEUTRAL] Uh, yes, I can check that for you. One moment.
[AGENT][NEGATIVE] And as of now for her, no, ma'am. It has not. But she has not used any benefits.
[CUSTOMER][NEUTRAL] OK, perfect. Um, so it would cover since she has used the
[AGENT][NEUTRAL] And because
[AGENT][NEUTRAL] And again, I cannot guarantee payment of benefits. We will have to receive the claim along with a copy of her primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] OK. Um, do you have a reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, you would use my name [PII] along with today's date and then one last thing, once we have received a claim and it's been processed by us, we do have a portal that you should also be able to check our claim status and and our website for that portal is located at [PII].
[CUSTOMER][NEUTRAL] OK. And sorry, could you tell me your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. OK, perfect, thank you.
[AGENT][POSITIVE] OK. Well, you're very welcome. So that is all I can help you with. Thank you again for calling APL [PII]. Have a great evening and the rest, great rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you, you too. Mm bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. All right. Bye-bye.