AccountId: 011433970860
ContactId: b21479f4-6db6-4ffb-9b55-e72f5ab30996
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302040 ms
Total Talk Time (AGENT): 155118 ms
Total Talk Time (CUSTOMER): 123125 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/b21479f4-6db6-4ffb-9b55-e72f5ab30996_20250217T19:12_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 [PII], good afternoon. My name is uh [PII]. I'm calling from a provider's office. I'm hoping you can help me. I needed to verify eligibility and benefits on one of my patients, please.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] It is 01.
[CUSTOMER][NEUTRAL] 982-592 M for Mary, L for Larry, and the number 8.
[AGENT][NEUTRAL] OK, thank you. So one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII], would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her name is [PII] and the last name is [PII] Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the subscriber on this supplemental policy and the policy is active, effective [PII].
[AGENT][NEUTRAL] So what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][POSITIVE] OK, alrighty.
[CUSTOMER][NEUTRAL] Well, it's gonna be um outpatient so we're we're the provider so we're the provider that's gonna be performing um patient's gonna be having surgery done um so we are gonna be billing professionally now I know you guys serve like a more like a secondary I guess uh primary has to process the claim. OK, so what is the benefit when a patient has like outpatient surgery for the provider and the facility?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We are.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it is, she has one outpatient benefit max.
[AGENT][NEUTRAL] And that is $500 per covered person per calendar day for covered outpatient services, and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK, so basically it's just you guys, well, the insurance process it only like $500 and it's only one payment of $500. That's the max. Let me just write this down too.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That is the max.
[AGENT][NEUTRAL] Well, I mean, that's the max per calendar day. Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me just write this down, so it's a $500.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm. Per calendar day max for covered outpatient services. Mhm.
[CUSTOMER][NEUTRAL] Max
[CUSTOMER][NEUTRAL] Per calendar.
[AGENT][NEUTRAL] And there is no outpatient deductible on the supplemental policy per calendar day.
[CUSTOMER][NEUTRAL] So you guys don't pick up the deductible in other words from the primary I guess.
[AGENT][NEUTRAL] No, I'm saying there's not a deductible on this policy. Some of these supplemental policies, there's also a deductible to be met, but this one does not have one.
[CUSTOMER][NEUTRAL] On the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when you all do send the claim for us to review, make sure that we were we also receive a copy of the primary EOB and then are you familiar already [PII] with our portal in which you all should be able to take claim status once we've processed the claim by going to secured? OK, so we have a our portal website is secured.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Triage 91 and 6 triage 91 and 6.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's a 5. Can you just repeat the benefit again for me? I, I, OK, so it's a $500 per.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the outpatient benefit maximum.
[AGENT][NEUTRAL] It's $500.
[AGENT][NEUTRAL] Per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For covered outpatient services with no outpatient deductible.
[CUSTOMER][NEUTRAL] Outpatient
[CUSTOMER][NEUTRAL] No deductible. OK, got it.
[AGENT][POSITIVE] Correct, yes ma'am.
[CUSTOMER][POSITIVE] OK, perfect. OK, and the policy is active. OK.
[AGENT][NEUTRAL] Mhm. Effective [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect. Alrighty, so that is all that I needed to know. Perfect, can I get a reference number for the call please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Name and date. Alright, [PII] thank you so much have yourself a great day.
[AGENT][POSITIVE] I hope you do too, [PII], and if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Uh, you're welcome