AccountId: 011433970860
ContactId: b259513c-afab-439e-9459-136b25ff784e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264480 ms
Total Talk Time (AGENT): 136976 ms
Total Talk Time (CUSTOMER): 145520 ms
Interruptions: 9
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/b259513c-afab-439e-9459-136b25ff784e_20250416T20:02_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] [PII], good afternoon. My name is [PII], and I was calling regarding the mutual patient. I wanted to see if you could help me out. Um, patient is going to be having, um, well, this is her secondary insurance, let me start with that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And she will be having a um outpatient surgery done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I wanted to see like how your benefit works, um, being the secondary insurance.
[AGENT][NEUTRAL] OK, so you're needing.
[CUSTOMER][NEUTRAL] And if there is any cost that I pick up? Mhm.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and benefits for a member, [PII], is that correct?
[CUSTOMER][NEUTRAL] Verify eligibility
[CUSTOMER][NEUTRAL] Yes, and to uh check if her if her primary doesn't um request authorization, would you also request an authorization if needed?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, yes, ma'am, I can help you with all of that. And what is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Yes, the policy number is 02431080.
[AGENT][NEUTRAL] Thank you. One moment while I get the information pulled up, please.
[AGENT][NEUTRAL] And any information [PII] that I did provide for you 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] Her name is [PII].
[CUSTOMER][NEUTRAL] 91666 appointment just sign in right there.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You're cold. Come touch me. How hot I am. I'm like literally sweaty.
[AGENT][NEUTRAL] OK, so I do show that she
[AGENT][NEUTRAL] OK, let's, any information, again, any information provided would be a verification of benefits and not a guarantee of payment. Would you verify her name and date of birth for me one more time, please?
[CUSTOMER][NEUTRAL] No, I'm not.
[CUSTOMER][NEUTRAL] it would be.
[CUSTOMER][NEUTRAL] Guarantee
[CUSTOMER][NEUTRAL] Of course, first name is [PII], last name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. Uh, so she is a subscriber on the supplemental policy, [PII], and it is active.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] With an effective date of [PII].
[CUSTOMER][NEUTRAL] I'm sorry, go ahead, yes ma'am.
[AGENT][NEUTRAL] OK. It is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] She has an outpatient benefit maximum per calendar year for covered outpatient services of $2550.
[CUSTOMER][NEUTRAL] And she has an outpatient benefit box and um.
[CUSTOMER][NEUTRAL] 25.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person.
[CUSTOMER][NEUTRAL] And there is no outpatient deductible.
[AGENT][NEUTRAL] For calendar year.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And there would not be any prior authorization or pre-cert required on this policy.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And I'll put that required.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, because it
[CUSTOMER][NEUTRAL] So out of pocket benefit 2550.
[AGENT][NEUTRAL] That's the maximum benefit that this plan would pay for covered outpatient services for calendar year.
[CUSTOMER][NEUTRAL] What's the maximum.
[AGENT][NEUTRAL] Now, because it is a supplement, when the claim is submitted to APO for review, we must also receive a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Can't be
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim here we do have a portal that you should be able to check our claim status in and the website for that portal is secured.
[CUSTOMER][NEUTRAL] It sounds like we have a portal that you can be able to check out like that and the website for that portal.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, well, [PII].
[AGENT][NEUTRAL] Secured. [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And I'll put website website.
[CUSTOMER][POSITIVE] Perfect. OK, thanks so much. I appreciate your time.
[AGENT][POSITIVE] Well, you, yes, ma'am, you're very welcome. So if that's all then that I can help you with today, thank you for calling APL Monica and I hope you have a nice evening.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Alright, you're welcome.
[CUSTOMER][POSITIVE] You're welcome bye bye.