AccountId: 011433970860
ContactId: b2afd188-f7f2-4222-bc66-5cdbbf71ff6c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292390 ms
Total Talk Time (AGENT): 156364 ms
Total Talk Time (CUSTOMER): 61471 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/b2afd188-f7f2-4222-bc66-5cdbbf71ff6c_20250523T18:37_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, I'm calling for some benefits for a patient.
[AGENT][NEUTRAL] OK, do you need benefits only or do you also need eligibility and benefits?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I'm asking you, do you need eligibility and benefits or only benefits?
[CUSTOMER][NEUTRAL] Eligibility and benefits.
[AGENT][POSITIVE] Yes, I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 02570559
[AGENT][NEUTRAL] Thank you. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And any information that I did provide for you, [PII] 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] She is [PII] and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Well, I'm sorry, what was the year?
[AGENT][NEUTRAL] A birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So I do show that he is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I would like to know the.
[CUSTOMER][NEUTRAL] Specialist benefits.
[AGENT][NEUTRAL] For a specialist office visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Just one moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so on this supplemental policy, an office visit is not covered.
[AGENT][NEUTRAL] If they receive some form of treatment in the physician's office, that can be reviewed under the outpatient benefit maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] However, the office visit fee itself is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you need the outpatient benefits for treatment?
[AGENT][NEUTRAL] Or just for the visit. OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $6000 with no deductibles.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] No deductible OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any co-payment or?
[AGENT][NEUTRAL] This is a supplemental policy to his primary insurance that helps with co-pays, deductibles, and co-insurance amounts of covered services. So when the claim is filed with us, [PII], you will need to also send a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then when we review the policy once it has been pro excuse me, when we review the claim once it's been processed, we do have a portal that you should also be able to check our claim status in and the website for our portal is located at [PII].
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][POSITIVE] Yes, ma'am. You're welcome.
[AGENT][NEUTRAL] So is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Well that will be.
[CUSTOMER][NEUTRAL] No, that's all for today. Can I get your name and reference code please?
[AGENT][NEUTRAL] Again, my name is [PII] and my name in today's date will be your call reference number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Well then, thank you. You're welcome and thank you for calling APL. I hope you have a nice weekend.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.