AccountId: 011433970860
ContactId: c2a578d9-75ab-46d0-bb3a-bc1a8fb195f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244600 ms
Total Talk Time (AGENT): 132852 ms
Total Talk Time (CUSTOMER): 79247 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/c2a578d9-75ab-46d0-bb3a-bc1a8fb195f5_20250210T14:26_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] Hi, [PII]. I'm calling from Memorial urgent Care. I'm calling to see if the patient's insurance covers a co-pay.
[AGENT][NEUTRAL] OK, so you're needing to verify benefits and eligibility for urgent care, is that correct? Yes, ma'am. I can help you with that. OK. And who am I speaking with, please?
[CUSTOMER][POSITIVE] Yes, please. That is correct.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Policy number, would it be?
[CUSTOMER][NEUTRAL] The outpatient benefit certification number?
[AGENT][POSITIVE] Yes, and you can get, that'll be, yeah, give me that one.
[CUSTOMER][NEUTRAL] 0, it's, I'm sorry, it starts off with 022 03929 ML 8.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][POSITIVE] You're welcome, no worries.
[CUSTOMER][NEUTRAL] Give me just one moment, OK?
[AGENT][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Memorial. I'm sorry, give me just one.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] Thank you so much for holding.
[AGENT][NEUTRAL] OK, so any, you're welcome, and any information, [PII] that I 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] Uh
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show here is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And he has an outpatient benefit max per calendar year for covered outpatient services of $6000 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when the claim is submitted.
[AGENT][NEUTRAL] To APL for review, [PII], we must also receive a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well, and then once we have processed our claim, we do have a portal in which you should be able to check claim status and have access to our EOB and the portal website for that is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is he covered for um office visits?
[CUSTOMER][NEGATIVE] That's not for you.
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] Office visits themselves are not covered.
[CUSTOMER][NEUTRAL] So if he has a co-payment with the primary insurance, the secondary does not pick it up.
[AGENT][NEUTRAL] Not for an office visit. Now, again, for urgent care, we can review and he does have a treatment writer on his policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But office visits themselves are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What if I provide you a CPT code? Would you be able to check for me?
[AGENT][NEUTRAL] No, ma'am, no ma'am, I can't do that because we will have to receive the primary insurance, EOB.
[CUSTOMER][NEUTRAL] And you can.
[CUSTOMER][POSITIVE] I understand. OK, perfect. Thank you so much. I appreciate it. Can I get a reference number for this call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, you're starting
[AGENT][NEUTRAL] You can. My, my name and today's date will be your call reference number.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] OK, well, you're certainly welcome and thank you again, [PII], for calling APL. I hope you have a very nice day.
[CUSTOMER][POSITIVE] You too, my dear. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.