AccountId: 011433970860
ContactId: c8d6522f-0448-464b-989d-d67e43050d1c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272059 ms
Total Talk Time (AGENT): 115582 ms
Total Talk Time (CUSTOMER): 123189 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/c8d6522f-0448-464b-989d-d67e43050d1c_20250305T22:03_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from a doctor's office calling to verify eligibility on a member.
[AGENT][NEUTRAL] OK, I can verify eligibility for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Miss [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] 02598409
[CUSTOMER][NEUTRAL] M like in Mary, L like in Linda, the number 8.
[AGENT][POSITIVE] OK, thank you so much. Uh give me a moment. And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and see, verify the patient's name, date of birth, please.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII] and he is active on the policy.
[CUSTOMER][NEUTRAL] OK and then um what kind of benefits or covers does he have um.
[AGENT][NEUTRAL] Well, with this policy is
[CUSTOMER][NEUTRAL] As far as office visit, mhm go ahead.
[AGENT][NEUTRAL] Oh, I'm sorry. It's a secondary supplemental plan, helps with primary insurance deductible, co-pay or co-insurance. Uh, the patient doesn't have any benefits for the office visit charge, but they do have a rider that covers treatment or procedures in the office if they are for a sickness or an injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it does not cover for the office visit but covers for treatment? I'm sorry, did I get that right?
[AGENT][POSITIVE] Correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so say if he has an office visit copay with the primary insurance, he's still responsible for that then, correct?
[AGENT][NEUTRAL] Correct, because that wouldn't be covered. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then if he has, like, for example, in the office, we do radiation therapy treatment and injection that we buy and bill for for prostate cancer. So if those would be considered uh covered benefits, correct?
[AGENT][NEUTRAL] Uh, that would be outpatient. Yes, ma'am. It will fall under the outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if he has a copay or any financial responsibility we would just have to bill um you guys correct?
[AGENT][NEUTRAL] Uh, yes, ma'am. You need to submit the billing and the primary EOB.
[CUSTOMER][NEUTRAL] OK and then um is there a specific claims address to submit that to?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII], [PII]. Excuse me, I'm trying to lose my voice, um [PII].
[CUSTOMER][NEUTRAL] And is there a coverage limit like for example, um, the plan would pick up the treatment coverage up until like a $5000 max or any specific max on the policy that it covers?
[AGENT][NEUTRAL] Uh, yes, ma'am. Um, not a guarantee of payment, just the verification coverage. The patient has an outpatient benefit of up to $1250 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Has anything been accumulated as of yet?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Uh, no, ma'am. I don't show he's used any benefits, so it is available.
[CUSTOMER][NEUTRAL] And then calendar year January through December, correct?
[AGENT][NEUTRAL] Uh, [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, perfect. So basically, um, let's say for example if the financial responsibility was 3500 as an example, um, the plan would only cover up to 1250 and then the patient would be responsible for the remaining amount, correct?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] OK, alright, perfect, um, so basically once that 1250 is reached for the year, then they're maxed out until the new year, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK perfect and there's no authorization or anything required to be obtained for any of the services, right?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][POSITIVE] OK, perfect. I you've answered all my questions. Can I have your name, first initial to your last name, and a reference number please, if there's one.
[AGENT][NEUTRAL] Uh, uh, my name is [PII], last initial [PII], and we don't give um call reference numbers, but you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, what was the last initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much for your help have a wonderful day.
[AGENT][POSITIVE] Oh, you too. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] Bye.