AccountId: 011433970860
ContactId: c5997234-01f6-43de-92a0-d868b26a2758
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248330 ms
Total Talk Time (AGENT): 115429 ms
Total Talk Time (CUSTOMER): 84741 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/c5997234-01f6-43de-92a0-d868b26a2758_20250514T16:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I'm calling from a dermatologist office, and we have a patient who had an office visit, and she had some additional procedures in office that her primary insurance says she has a deductible for, and she wanted to know if her, um, APL plan would cover that deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's take a look at it. What is the policy number?
[CUSTOMER][NEUTRAL] Um, that is 016.
[CUSTOMER][NEUTRAL] 823
[CUSTOMER][NEUTRAL] 24 M.
[CUSTOMER][NEUTRAL] And I don't know if there's another oh it looks like there's another two numbers that are scratched out. I think it's ML 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, patient is active. The effective date is [PII]. Um, we are their secondary insurance. Let me just see.
[AGENT][NEUTRAL] If this covers any sort of
[AGENT][NEUTRAL] So the only thing that the patient's plan does not cover would be the physician office visit fee. It does cover treatment in an office. Um, their outpatient benefit max for the year is $4000. So it does cover like deductible, co-pay, and co-insurance. Um, it just looks like the physician cover charges do not include the office visit fee.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so procedures though are we can file for OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, and then do we just
[CUSTOMER][NEUTRAL] Mail the claim or can we fax it or?
[AGENT][NEUTRAL] Yeah, so we, uh, excuse me, we can accept claims in the mail electronically or via fax, and I can give you that info.
[CUSTOMER][NEUTRAL] OK, great. Let me take the information then.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] The uh payer ID if you want that is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the fax number is going to be 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then our claims mailing address would be [PII].
[AGENT][NEUTRAL] 248.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All right, thank you so much for your help. Is there any like reference number I should take or?
[AGENT][NEUTRAL] Yeah, absolutely. So call reference is gonna be my name with my last initial and then today's date. My name again is [PII], that's [PII] and then my last initial is [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.