AccountId: 011433970860
ContactId: aa412811-0618-405f-a8d1-63e63fd1be70
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 661479 ms
Total Talk Time (AGENT): 295422 ms
Total Talk Time (CUSTOMER): 259184 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/aa412811-0618-405f-a8d1-63e63fd1be70_20250617T18:25_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] Hey, [PII]. Good afternoon. This is [PII] calling from the provider's office to check for an eligibility.
[AGENT][NEUTRAL] OK, you're needing eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][POSITIVE] Oh yes ma'am, I can help you with that and I'm so sorry, what is your first name again?
[CUSTOMER][NEUTRAL] selling
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 02011
[CUSTOMER][NEUTRAL] 238.
[AGENT][NEUTRAL] Thank you. One moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Informing any information that is provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], OK. [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And again, do you need eligibility and benefits? Is that correct? Or just eligibility?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Both actually.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do show that she is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefits do you need for her today, [PII] inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK. So, benefit what I need is about the copay for PCP as well as specialist. Deductibles and out of pocket, and also check for a provider whether he's in-network or out of network.
[AGENT][NEUTRAL] OK, so this is a supplemental policy to her primary healthcare insurance that's designed to help her with her co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Supplementary policy, right?
[AGENT][NEUTRAL] So you're wanting to verify if there are
[AGENT][NEUTRAL] One more there and there's no network with APL, it would follow her primary insurance company?
[AGENT][NEUTRAL] And you're needing to know if office visits are covered, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so on this supplemental policy, office visits are not covered under this plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If she were
[AGENT][NEUTRAL] Yes, if she were to receive some form of treatment in the office, that is something that we could, could be reviewed, but the office visit itself is not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Both PCP as well as specialist visit, right?
[AGENT][NEUTRAL] The office visit is not covered.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Uh, what about any other co-payments? Is it, uh, applicable here?
[AGENT][NEUTRAL] I'm sorry, I didn't understand your question.
[AGENT][POSITIVE] This plan helps with her co-pays. This plan helps with her co-pays and deductibles and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] Uh, any
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. So, there is no deductibles.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] There is no deductible on this plan. Office visits are not covered. If she receives some form of treatment in the office, we could review that, as I stated before, under her outpatient benefit, which is $1500 per calendar year for covered outpatient services, and there is no outpatient deductible per covered person.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Her calendar year on this supplemental policy.
[CUSTOMER][NEUTRAL] OK. Thank you for that. Can you check if there any out of pocket just for confirmation?
[AGENT][NEUTRAL] We are not a major medical insurance company. You would need to contact her primary insurance to find out that.
[AGENT][NEUTRAL] That does not apply to this policy.
[CUSTOMER][NEUTRAL] OK. So this is a
[CUSTOMER][NEUTRAL] So this is a secondary policy that meant?
[AGENT][POSITIVE] That's correct, yes ma'am, uh huh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, thank you for that. And um can I get the time limit for a claim submission, please?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] No, none.
[AGENT][NEUTRAL] None.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With us, no, ma'am.
[CUSTOMER][NEUTRAL] Mm. And again, just to
[AGENT][NEUTRAL] But if you do end up submitting a claim.
[AGENT][NEUTRAL] If you do end up filing a claim with APL, you must send us also a copy of her primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim here [PII], we have a portal in which you should be able to check the claim status for APL and that portal website is located at [PII].
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Just one more question. So this is the supplementary policy and what about the like
[CUSTOMER][NEUTRAL] Providers check whether he's in network or out of network.
[AGENT][NEUTRAL] There's no network with APL.
[CUSTOMER][POSITIVE] OK, thank you for that. And uh
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, OK. Just for confirmation, is there any primary care physician mentioned in this policy?
[CUSTOMER][NEUTRAL] By plan.
[AGENT][NEGATIVE] Not on this, not on this supplemental policy, office visits are not covered.
[CUSTOMER][NEUTRAL] Uh, uh, so there's no doctor too, right? Like recommended doctor, something like that.
[AGENT][NEGATIVE] Uh, I don't understand what you're asking.
[CUSTOMER][NEUTRAL] I'm asking for a PCP on file, means primary care physician on file.
[AGENT][NEUTRAL] Yes, ma'am, that would not apply to this supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, just for confirmation, the, it is a supplement policy and, uh, is there any other type?
[AGENT][NEUTRAL] No, but there is not.
[CUSTOMER][NEUTRAL] Can you specify just to mention here? OK, just supplement policy.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, thank you. And can I get the payer ID please?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Just for confirmation, payer ID is 60801.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] The city name is two words. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, and then um yeah gotcha. And is there any fax number?
[AGENT][NEUTRAL] [PII]. Attention claims department.
[CUSTOMER][NEUTRAL] Thank you. And yeah, I'm gonna just for confirmation, I'm gonna like read out. So the policy is still active, right?
[CUSTOMER][NEUTRAL] From [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's a supplementary policy.
[CUSTOMER][NEUTRAL] So, secondary.
[CUSTOMER][NEUTRAL] So timely find limit is none.
[CUSTOMER][NEUTRAL] So we need to check on primary policy for that. Also, co-pay, deductible out of pocket, none, right?
[CUSTOMER][NEGATIVE] No benefits you mentioned?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Am I correct? OK.
[CUSTOMER][NEUTRAL] But for office visit? There's nothing.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And earlier you told me about a $1500 something, right?
[AGENT][NEUTRAL] I said her outpatient. No, ma'am. I said that her outpatient benefit maximum per calendar year for covered outpatient services under this policy is $1500 with no deductible.
[CUSTOMER][NEUTRAL] Which is applicable? What was that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK. Can you please repeat it so that I can read out here. Sorry about that.
[AGENT][NEUTRAL] The outpatient benefit maximum.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Her calendar year.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For covered outpatient services.
[AGENT][NEUTRAL] Is 1000.
[CUSTOMER][NEUTRAL] Outpatient services.
[AGENT][NEUTRAL] Uh-huh, it's $1500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] And there is no outpatient deductible?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Per covered person.
[CUSTOMER][POSITIVE] Cover the person. Thank you for that.
[AGENT][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Thank you. OK. So can I get your name again, please, [PII], right?
[AGENT][NEUTRAL] [PII], that's correct. And you're gonna use my name and today's date, [PII], if you need a call reference number.
[CUSTOMER][NEUTRAL] Mhm. Yeah. And is there any, can I get your last name first initial?
[AGENT][NEUTRAL] [PII], and yours?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK. So thank you for assisting me today. Have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] Well, I hope you have a great day too. Yes, [PII]. So if that's all I can help you with, thank you again for calling APL and I hope you have a great rest of your day as well.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Uh