AccountId: 011433970860
ContactId: b3af179a-25a0-4a8b-b264-5beac0f5a8de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 613869 ms
Total Talk Time (AGENT): 262140 ms
Total Talk Time (CUSTOMER): 127837 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/b3af179a-25a0-4a8b-b264-5beac0f5a8de_20250522T20:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi um good afternoon [PII]. I was calling to get eligibility and benefits for some patients.
[AGENT][NEUTRAL] OK, how many patients do you need eligibility and benefits for?
[CUSTOMER][NEUTRAL] It's just gonna be for 2 patients.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII] [PII]
[AGENT][NEUTRAL] OK, thank you, [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] That's gonna be [PII].
[AGENT][NEUTRAL] Thank you. And where are you calling from today, [PII]?
[CUSTOMER][NEUTRAL] Will calling from.
[CUSTOMER][NEUTRAL] Um, I'm calling from Asthma and allergy Associates of Florida.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you will use my name, [PII], for your call reference number for each patient along with today's date.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then any information that I do provide for you on the members will be a verification of benefits and not a guarantee of payment. So what is your first patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, that's gonna be, um, excuse me, 01659530 M as in Mike L as [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] What is your patient's name, please, [PII], and date of birth?
[CUSTOMER][NEUTRAL] Yes, patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I need to give you an updated policy number because the policy number that you gave me is no longer active.
[CUSTOMER][NEUTRAL] So I need to give you an updated policy number.
[AGENT][NEUTRAL] That is an older policy number and that policy term date actually was 11 of 2024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The current active policy is going to be 02502544.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it has an effective date on it of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment to get that information pulled up.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's gonna be for an office, um, for a specialist office is it and then for allergy services, so skin testing, injection and serum.
[AGENT][NEUTRAL] So on this outpatient, I'm sorry, on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $2500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] When you do submit the claim with this market for this number, we will have to have a copy of the primary insurance company's explanation of benefits as well for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we process our claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We do have a portal that you should be able to check claim status in and that website is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um would the office of the co-pay be covered by the by that benefit or no?
[AGENT][NEUTRAL] This particular policy, it can be reviewed for under the outpatient benefit.
[CUSTOMER][NEUTRAL] OK and then have they met anything towards that um that benefit so far?
[AGENT][NEUTRAL] As of now, she has not.
[CUSTOMER][NEUTRAL] OK, alrighty and then um.
[CUSTOMER][NEUTRAL] OK and then if we can look for another patient.
[AGENT][NEUTRAL] OK, so give me just a moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that portal website that I gave you would be applicable for, you know, any member that has a policy with us if you all file a claim for them.
[AGENT][NEUTRAL] And then what's the next, um, policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's gonna be um 01659749 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'm just gonna go ahead and let you know that that policy before I even look up a member, that's an old policy as well, that termed 11 of 2024.
[CUSTOMER][NEUTRAL] OK, so I'm just gonna go
[AGENT][NEUTRAL] There's an active policy under this subscriber and that policy number is 02502639.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and that policy, this one is active effective [PII]?
[AGENT][NEUTRAL] And what is your patient's name and date of birth for this one?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show again that that uh floor is the subscriber and yes it is active with that new policy number effective [PII] and then what type of benefit information do you need for this member inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's gonna be for um office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $2500 per covered person, and there is no outpatient deductible for covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and then has she meant anything towards that benefit?
[AGENT][NEUTRAL] I can check that.
[AGENT][NEUTRAL] As of now,
[AGENT][NEUTRAL] There has been $70 used.
[CUSTOMER][NEUTRAL] OK, and then what about for the actual um, specialist office is it could be?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let me look at this policies, policy to see if it is divided out. I'm not sure. Let me give me just a moment or if it falls under that outpatient benefit.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Each of these supplemental policies are different. OK, give me just a second.
[CUSTOMER][NEUTRAL] supplemental
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so let's let me get back here.
[AGENT][NEUTRAL] OK, so for a let me adjust some information. Give me just a moment I just.
[CUSTOMER][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for a specialist office visit on this plan, the benefit is up to $50 per visit and a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, and then have they used any of those 4 visits?
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] And as of now they have used one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alrighty [PII] thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. So, is there anything else, [PII], that I can help you with?
[CUSTOMER][POSITIVE] Um, no, that'll be it, thank you.
[AGENT][POSITIVE] OK, well then thank you for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][POSITIVE] Thank you, bye bye.