AccountId: 011433970860
ContactId: b8f29b24-3625-4a81-a7e3-3e814dda5433
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240479 ms
Total Talk Time (AGENT): 136976 ms
Total Talk Time (CUSTOMER): 73762 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/b8f29b24-3625-4a81-a7e3-3e814dda5433_20250207T20:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling from the provider's office. We have a patient who um has an APL card we're trying to figure out if it covers office visit specialist.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] OK. Uh-huh. It's OK. I can definitely let you know of the member's office visit coverage. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. My first name is [PII] Phone number [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, um.
[CUSTOMER][NEUTRAL] It says outpatient benefit certification number, is that it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, 02585907 M as in Michael, L as in Larry, the number 8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active, it's been effective since [PII]. And hold on one moment, I'm just pulling up the benefits so I can check for the specialist.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Oh, that's fine.
[AGENT][NEUTRAL] OK, so for outpatient, excuse me, the policy will pay up to $1500 per person per calendar year. There is no deductible.
[AGENT][NEUTRAL] The policy itself does not have any in-office coverage in terms of like if you charge for a facility charge, but they do have the office treatment rider in which any treatment done in the office setting could be covered up to that 1500 per year, and that goes for physicians, specialists. So for that, the treatment um could be covered.
[CUSTOMER][NEUTRAL] So is the co-pay covered?
[AGENT][NEUTRAL] So we pay towards the copay, deductible and co-insurance of covered charges after primary. So if you, um, if they have to pay that co-pay to be seen, then on the back end once you file the claim with us, they could be reimbursed or if there's still something owed to you, we could pay to you up to that 1500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Up to $1500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry. So then how much has it been used so far?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] For [PII], none of the benefits have been used yet.
[CUSTOMER][NEUTRAL] And then, so is it because it has a limit of only $1500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it better to just have wouldn't it be better to have the patient pay and then they can get reimbursed? Sorry.
[AGENT][NEUTRAL] Right, so it depends on your facility. If, if you, if your facility requires the payment upfront, then yes, they're gonna have to pay upfront, but you know, sometimes if it can be billed, then we will handle it on the back end and then there wouldn't be a reimbursement, but it depends on
[CUSTOMER][NEUTRAL] Right, but the concern is obviously if the patient runs out of benefit, then we don't get paid.
[AGENT][NEUTRAL] Correct. If it's, if they've used that full 1500 by the time that claim comes in, it won't be processed, it will be denied, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it right, and so can I get a reference number for this call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial of my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] [PII]. OK, thank you so much and I appreciate it.
[AGENT][POSITIVE] You're very welcome, [PII]. Thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too thanks bye.
[AGENT][POSITIVE] You're welcome bye bye.