AccountId: 011433970860
ContactId: bbc82a7d-a03d-401a-8872-719ad9e73a96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360670 ms
Total Talk Time (AGENT): 151034 ms
Total Talk Time (CUSTOMER): 100680 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/bbc82a7d-a03d-401a-8872-719ad9e73a96_20250224T18:02_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 [PII], um, I'm calling from a provider's office for a mutual member. I just wanted to confirm eligibility and benefits for if you could help me with that please.
[AGENT][NEUTRAL] Sure, you're needing eligibility and benefit information for one patient, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] [PII] like the city, yeah.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] It'll be [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] It'll be 021-72770.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII] and any information that I do provide for you today 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] The name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, so I do show that he is a dependent on the supplemental policy and the supplemental policy, Berlin 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] Um, so it's for a specialist office visit. Do you have, um, this insurance as like their secondary? I mean, you said it was a supplemental, right? OK, do you have their prime.
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] Correct. We are not a major.
[CUSTOMER][NEUTRAL] Got it, got it. No, I think the phone is delayed.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Yeah, we are not a major medical. Oh yeah, I think there is a little bit. Yes, we are not a major medical carrier. This would be a supplemental policy only to the primary insurance. Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK perfect and then um so I just wanted to confirm um what the supplemental policy would cover their primary insurance I have here is with UMR um would they cover like the copay or anything like that or how would that work for a specialist office visit?
[AGENT][NEUTRAL] OK, let me pull up the benefits on this policy to see what they are for the office.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so just a moment, please.
[CUSTOMER][POSITIVE] No problem, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, it's just taking a moment for my information to load. I'm sorry. Thank you for your patience.
[CUSTOMER][POSITIVE] No worries. No worries. You're good.
[CUSTOMER][NEUTRAL] You answered pretty fast. Sometimes I'm waiting 1015 minutes just to talk to someone, so.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Totally fine.
[AGENT][NEUTRAL] OK. OK. So on the physician writer that's on this policy, the benefit is $25 per visit with a maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Max 4 visits per member per calendar year.
[AGENT][POSITIVE] Mhm, that is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when the claim, um, if you will file a claim with us early, we will also need to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Along with the claim for review and then once we have processed our claim, the we do have a portal in which you should be able to check claim status and that portal website is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, that would be you said the active effective date was [PII], right?
[AGENT][POSITIVE] That is correct for this policy. Mhm.
[CUSTOMER][NEUTRAL] OK perfect no that would be all [PII] if I could just get um a reference number for this call, that'll be it please.
[AGENT][NEUTRAL] Yes, ma'am. Um, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much that'll be all OK?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome, ma'am. So if that is all I can help you with, thank you again for calling APL Berlin. I hope you have a great day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you too. Bye-bye.