AccountId: 011433970860
ContactId: a86d0848-2119-4654-a8d9-b337b5ed8805
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248899 ms
Total Talk Time (AGENT): 135649 ms
Total Talk Time (CUSTOMER): 48432 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/a86d0848-2119-4654-a8d9-b337b5ed8805_20250402T17:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, I just need to check eligibility.
[AGENT][NEUTRAL] OK, you're only needing eligibility for a member you do not need benefits, is that correct?
[CUSTOMER][NEUTRAL] I'm sorry, could you repeat that?
[AGENT][NEUTRAL] You only need eligibility, you do not also need benefits, is that correct?
[CUSTOMER][POSITIVE] Sure, yeah, I, I'll take the benefits.
[AGENT][NEUTRAL] You need eligibility and benefits.
[CUSTOMER][NEUTRAL] Sure, yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you.
[CUSTOMER][NEUTRAL] Is this just for prescription, is that what this is?
[AGENT][NEUTRAL] We offer a lot of different types of plans, so I would have to pull the member's information first to be able to answer that question for you. So who am I speaking with please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And, OK.
[AGENT][NEUTRAL] And then what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Uh, policy number is 02493414.
[AGENT][NEUTRAL] OK, thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, name any information that I do provide for you 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] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now he is the subscriber on the supplemental policy, and this supplemental policy.
[AGENT][NEUTRAL] It's still showing as active with an effective date of [PII].
[AGENT][NEUTRAL] And this again, it's a supplemental plan and to his primary insurance that helps him with his co-pays, deductibles, and co-insurance amounts of coverage services. Prescription, there's no prescription benefit on this plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it helps with the co-pays correct?
[AGENT][NEUTRAL] Correct. I've covered outpatient services or in hospital admission.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am. Now if you all are, but were you calling specifically for prescription information?
[CUSTOMER][NEUTRAL] No, I wasn't sure if it was a prescription because it says.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, it was a truck type of uh coverage it was.
[AGENT][NEUTRAL] Yes, ma'am. This is a supplemental.
[CUSTOMER][NEUTRAL] I just need to make sure that it was still active.
[AGENT][NEUTRAL] Right, we are showing the policy is still active now if you all will be filing a claim with APL for this member, we would have to have a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well as the claim for review and then also um once we've processed the claim we do have a portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Well, is there anything else that I can help you with? You're certainly welcome. And is there anything else I can help with?
[CUSTOMER][POSITIVE] Well thank you very much.
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Well, you're welcome and thank you again for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.