AccountId: 011433970860
ContactId: bf9d8e03-07d5-4108-9501-f16d7e6715ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265649 ms
Total Talk Time (AGENT): 148913 ms
Total Talk Time (CUSTOMER): 111729 ms
Interruptions: 7
Overall Sentiment: AGENT=2.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/bf9d8e03-07d5-4108-9501-f16d7e6715ef_20250530T14:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. I'm [PII]. We're the provider patient eligibility and benefits, please, [PII].
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with those things, [PII], and what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number.
[CUSTOMER][NEUTRAL] OK. It says it's 261-1481?
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. So I do show she is the subscriber on the supplemental policy and it is active with an effective date of [PII]. And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient urgent care? Did you have outpatient urgent care coverage?
[AGENT][NEUTRAL] OK, the outpatient benefit maximum per calendar year for covered outpatient services is $6500.
[AGENT][NEUTRAL] And there is no deductible.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. So she does have an outpatient urgent care coverage?
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] Correct. That is something that can be reviewed under her outpatient benefit maximum.
[AGENT][NEUTRAL] And because this is a supplement to her primary insurance, [PII], when the claim is submitted to APL for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well. And then once we have processed our claim, we do have a portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Thank you so much. OK, um, well, I have, and then this is a supplementals the meddling, so meddling is the meddling is the supplemental policy supplemental. I'm I'm learning the knowledge instead of saying gap, instead of saying gap because someone told me you guys either have indemnity plans or you either have the med link. So I learned that that's why I asked this is indemnity med meddling is the supplemental. Uh-huh.
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Supplemental. That is correct. That is correct. Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, in the med like it. Yeah, yeah.
[AGENT][POSITIVE] Correct. You've got it.
[CUSTOMER][POSITIVE] I, I've, I've, I've, I've learned, I've learned.
[AGENT][POSITIVE] Uh, yeah, you're learning well then then you're exactly correct.
[CUSTOMER][NEUTRAL] Well, you have, you know, it's important to know these things and, and, and now I talk about people all the time like people put the planning is as the third party, OK, but you can't assume that the third party is their insurance company who's the insurance carrier sometimes they can be, but never assume.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Right. That's exactly right. But absolutely, you're correct in that. But you have this right. This Medin is a supplemental policy that uh in addition to their primary, well, it's a pri it's our primary insurance. It's not a Medicare supplement. It is a private, major medical, yeah, medical plan. Mhm.
[CUSTOMER][NEUTRAL] I just, I, I, you know.
[CUSTOMER][NEUTRAL] Right, Medicare, Medicare is not policy.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That's what I meant medical, sorry, it sounds, yeah, her medical supplement. I, I'm so used to saying Medicare.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Uh, and TRAC.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] All right?
[AGENT][POSITIVE] Yes, that is correct. OK, [PII].
[CUSTOMER][POSITIVE] Thank you and and thank you for everything.
[AGENT][POSITIVE] Today's date. Well, you are very welcome and thank you for calling APL and I hope you have a great weekend, [PII].
[CUSTOMER][NEUTRAL] Alright you too bye bye, [PII].
[CUSTOMER][POSITIVE] Oh thanks you too bye bye [PII].
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.