AccountId: 011433970860
ContactId: b9decae6-48bb-4bf1-bfc0-b30b9a34aba6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261220 ms
Total Talk Time (AGENT): 123453 ms
Total Talk Time (CUSTOMER): 62831 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/b9decae6-48bb-4bf1-bfc0-b30b9a34aba6_20250415T16:51_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] Yes, this is [PII] with Piedmont Pain Management. I just need to verify a patient of ours to make sure that they have are they're insured by you all.
[AGENT][NEUTRAL] OK, [PII], you're just needing eligibility, is that correct? not benefits?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes ma'am I can help you with that and what is.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] You do or don't need benefits? Do you or do you not need benefits also?
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I do need benefits.
[AGENT][NEUTRAL] So you need eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes, ma'am, I can help you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] I was given 02452346.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Let's see. First name is gonna be [PII], last name [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So I do show, oh excuse me, I do show she is a subscriber on the supplemental policy. It is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Oh patient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so 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 cover person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy handed to the primary insurance when the claim is submitted to APL for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here at APO we do have a portal in which you should be able to check claim status.
[AGENT][NEUTRAL] And our website for the portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And as of now she has not used any of these benefits for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and um I was on the phone earlier with someone before it got disconnected. They said that we weren't able to get this information faxed over to us, is that right?
[AGENT][NEUTRAL] Um.
[AGENT][POSITIVE] That is, that is correct.
[CUSTOMER][POSITIVE] OK. All right, then that is all I need at this time. Thank you so much for all your help.
[AGENT][NEUTRAL] And do you know who you were, yes, ma'am, and do you know who you were speaking with? And you said you got disconnected.
[CUSTOMER][NEUTRAL] I don't. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, I'm not sure who it was, honestly.
[AGENT][NEUTRAL] Oh, OK. Well, I'm sorry that that happened, [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Not a problem. Thank you so much again for all your help.
[AGENT][POSITIVE] Well, you, yes ma'am, you're welcome. So again, if that is all I can help you with, thank you so much for calling APO and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] You as well. Thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you too. Bye-bye.
[CUSTOMER][NEUTRAL] Uh huh bye bye.