AccountId: 011433970860
ContactId: ae2ce8dc-1cb2-46ff-8883-c2aa55a1bef5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268399 ms
Total Talk Time (AGENT): 149271 ms
Total Talk Time (CUSTOMER): 186591 ms
Interruptions: 17
Overall Sentiment: AGENT=2.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/ae2ce8dc-1cb2-46ff-8883-c2aa55a1bef5_20250521T18:57_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, good afternoon. My name is [PII]. I'm calling from a doctor's office trying to verify benefits for a patient.
[AGENT][NEUTRAL] OK, [PII], so you're needing to verify benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Both.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. Do you also need eligibility or strictly just benefits?
[AGENT][POSITIVE] Yes, I can help you with both and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] It's 02141794 ML 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] networking and reimbursement.
[AGENT][NEUTRAL] And 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].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Blue Shield.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] That services are available to every week.
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] It's outpatient. I need to know if you cover for the specialist office visit copy.
[AGENT][NEUTRAL] On this supplemental policy,
[CUSTOMER][NEUTRAL] Find out more about Snapchat.
[AGENT][NEUTRAL] He does have an office visit writer in which we can review for benefits under his outpatient benefit maximum.
[AGENT][NEUTRAL] And the outpatient benefit maximum per calendar year per covered person for covered outpatient services is $7900 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] you know.
[CUSTOMER][NEUTRAL] That's all.
[CUSTOMER][NEUTRAL] So is this a cover service?
[AGENT][NEUTRAL] We can review for benefits, yes ma'am for office visits under this policy.
[CUSTOMER][NEUTRAL] Transa.
[CUSTOMER][NEUTRAL] Referrals and remittance.
[CUSTOMER][NEUTRAL] Sorry, it's not clear. Do you cover for the copy or not?
[AGENT][NEUTRAL] I cannot guarantee payment. It is something that we can review for, yes ma'am.
[CUSTOMER][NEUTRAL] OK, OK, so you review for it if it is OK.
[AGENT][NEUTRAL] So when you all submit?
[AGENT][NEUTRAL] Yes, and when you submit the claim to us, correct, along with the primary insurance company's explanation of benefits, we must receive a copy of that with the claim.
[CUSTOMER][NEUTRAL] OK, so we need to submit a claim to find out.
[CUSTOMER][POSITIVE] Helpful.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you cover for procedures in office like a sleep studies?
[AGENT][NEUTRAL] That can also
[CUSTOMER][NEUTRAL] Yeah the same.
[AGENT][NEUTRAL] Office treatment. He also has a writer for office treatment. So office treatment and office visits can be reviewed under this supplemental policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and what about DME?
[CUSTOMER][NEUTRAL] Is it the same or not the mean? OK, may I have a reference number for the call? OK.
[AGENT][NEGATIVE] No, ma'am. DME is not covered. No, ma'am. DME is not covered.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date.
[AGENT][NEUTRAL] And then if you will end up filing the claim with us [PII] for this member once it's been processed by APL, we do have our portal that you should be able to check claim status in and the website for that is [PII].
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] press one now.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK. Well, well, you're very welcome. So again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that was it thank you very much.
[AGENT][POSITIVE] OK, well, you're welcome and thank you for calling APL. I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you, bye bye.