AccountId: 011433970860
ContactId: b86be8c8-8c36-48cd-889f-aed58d2a083e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313230 ms
Total Talk Time (AGENT): 154256 ms
Total Talk Time (CUSTOMER): 90798 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/b86be8c8-8c36-48cd-889f-aed58d2a083e_20250519T19:06_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], I'm calling from an ambulatory service center and I have a patient that's coming up for an appointment and I'm just trying to verify her benefits.
[AGENT][NEUTRAL] OK. You're needing to verify, do you also need eligibility or only benefits?
[CUSTOMER][NEUTRAL] Um, eligibility and benefits, um, and this insurance popped up under her primary insurance.
[AGENT][NEUTRAL] OK. I can help you with these things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII] I'm calling from the upper, I'm calling from the Upper West Side endoscopy.
[AGENT][POSITIVE] Thank you and [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And what is the, I'm sorry, what is your callback number?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] The members what number? I'm sorry?
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] See, that's the thing. I am not too sure. Like I said, this is a secondary that popped up under their primary insurance.
[AGENT][NEUTRAL] OK, what is the member's full social?
[AGENT][NEUTRAL] So I can locate their information.
[CUSTOMER][NEUTRAL] That I don't have either.
[CUSTOMER][NEUTRAL] So, OK, so I would need her social or her policy number, correct?
[AGENT][NEUTRAL] I can try but I cannot search by date of birth. I can try by the name, but if it's a very common name, that may be difficult.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Her name is [PII]
[AGENT][NEUTRAL] Um, we can try it. Let's see.
[AGENT][NEUTRAL] What state does she live in?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, I may have located a policy for her 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 her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] OK, so again, any information provided will be a verification of benefits and not a guarantee of payment, but she is the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And you need outpatient benefits for her, is that correct?
[CUSTOMER][NEUTRAL] Uh, ambulatory out of the outpatient hospital or ambulatory surgical center. She's coming in for a colonoscopy.
[AGENT][NEUTRAL] OK, so the Alps.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $1500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there is no outpatient deductible for covered person per calendar year.
[AGENT][NEUTRAL] Because it is a supplemental policy shown to her primary insurance, when the claim is filed with APL, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed the claim here at APO we do have a portal in which you should be able to check claim status in.
[AGENT][NEUTRAL] And our website for that is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy number that you need to have for Miss [PII] is 179.
[AGENT][NEUTRAL] 5249.
[CUSTOMER][NEUTRAL] Can I read that back to you?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1795249.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much. um, there's no copay or anything, correct?
[AGENT][POSITIVE] Yes. Yes, ma'am. You're very welcome.
[AGENT][NEUTRAL] This plan is a supplemental policy that helps with her co-pays, deductibles, and co-insurance amounts of coverage services up to the benefit maximum.
[CUSTOMER][NEUTRAL] Right, so, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. So, can I help you with anything else today?
[CUSTOMER][NEUTRAL] No, that is it.
[AGENT][POSITIVE] Well then, thank you very much for calling APL and I hope you have a great rest of your day, [PII].
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Um, thank you too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.