AccountId: 011433970860
ContactId: bd779391-c514-42f1-970e-8dc3a7ffa3d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283989 ms
Total Talk Time (AGENT): 126579 ms
Total Talk Time (CUSTOMER): 65049 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/bd779391-c514-42f1-970e-8dc3a7ffa3d0_20250523T12:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling you from Acumen. I have a patient coming in today for a procedure stating that you guys are their secondary carrier calling for benefits.
[AGENT][NEUTRAL] OK, [PII], you only need benefits. You already have eligibility, is that correct?
[CUSTOMER][NEUTRAL] Uh, I'll take, yeah, eligibility and benefits.
[AGENT][POSITIVE] OK, yes ma'am I can help you with both and what is your callback number?
[CUSTOMER][NEUTRAL] [PII], that is correct.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] I have 021-95167.
[AGENT][POSITIVE] Oh, I'm so sorry. Could you please repeat that one more time? I missed one of the numbers.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh no problem. I have 021-95167.
[AGENT][NEUTRAL] 02195167. Is that correct?
[CUSTOMER][NEUTRAL] Yes, 5167.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And any information that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show and again any information provided will be a verification of benefits and not a guarantee of payment. I do show that Ms. [PII] is the subscriber on the supplemental policy, [PII], and yes ma'am, it is active with an effective date of [PII].
[AGENT][NEUTRAL] And do you need inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Uh, office.
[AGENT][NEUTRAL] An office
[CUSTOMER][NEUTRAL] We're outpatient diagnostic imaging, but we do bill, yeah, we're outpatient diagnostic imaging, but we do bill as an office to code 11.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so on the supplemental policy, her outpatient benefit maximum per calendar year for covered outpatient services is $1000.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Now, when the claim is submitted to APL we will have to also receive a copy of her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And once the claim has been processed here at APL, we do have a portal, [PII], in which you should be able to check our claim status and the website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And for billing purposes are we seeing I just have the PO box of 248,950.
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] Perfect, [PII], is there a reference number for our call?
[AGENT][POSITIVE] Yes, ma'am, you will actually use my name along with today's date.
[CUSTOMER][NEUTRAL] This is to your last?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] [PII], and I don't believe you gave me yours either.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And again, [PII], is there anything else I could help you with?
[CUSTOMER][POSITIVE] No, that is all thank you so much.
[AGENT][POSITIVE] Well, you are very welcome and thank you again for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You do the same.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.