AccountId: 011433970860
ContactId: bcbde575-6f1e-407d-94b5-4e9ea83277b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262480 ms
Total Talk Time (AGENT): 123487 ms
Total Talk Time (CUSTOMER): 72329 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/bcbde575-6f1e-407d-94b5-4e9ea83277b8_20250312T12:02_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, I'm calling about a patient who has a procedure at our facility today, and I see that they have an APL and I was just wondering if they would be able to or if they have any active benefits that they can use.
[AGENT][NEUTRAL] OK, so you're wanting to verify eligibility and benefit for a member who's having an outpatient procedure, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] This is [PII], uh, working at Galloway endoscopy Center.
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] The member's policy number is 16701.
[AGENT][NEUTRAL] OK, now that's not a policy number, that would be a group number.
[CUSTOMER][NEUTRAL] No, got you. Would it just be the certain number then?
[AGENT][NEUTRAL] There should be another number.
[AGENT][NEUTRAL] Policy certificate number, policy er number?
[CUSTOMER][NEUTRAL] No, I got you. I have it here it's gonna be 01854359 ML 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's going to be [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that she is the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And she has an outpatient benefit max per calendar year for covered outpatient services of $1500 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Now, because this is a supplemental policy to her primary insurance, when the claim is submitted to APO we will have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once the claim has been processed by APO we do have a portal in which claim status should be able to be checked for us and our website for the portal is [PII].
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] And how much has she used of the 1500?
[AGENT][NEGATIVE] As of this moment, she has not used any benefits.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] And then let me just check this here real quick.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Did you say it covers copays, co-insurance and deductible, or?
[AGENT][NEUTRAL] Yes, it covers co-pays, deductibles, it helps them with the co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][POSITIVE] Got you perfect and can I have a reference number for this call, please?
[AGENT][POSITIVE] Yes, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Got you OK and you said it was [PII]?
[AGENT][NEUTRAL] I did, yes. Uh-huh.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] And is there anything else, [PII], that I can help you with this morning?
[CUSTOMER][POSITIVE] No, that'll be all thank you very much.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks, bye bye.