AccountId: 011433970860
ContactId: cbf45e49-1a7e-4531-ad29-a0a37e6878da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295559 ms
Total Talk Time (AGENT): 142408 ms
Total Talk Time (CUSTOMER): 144394 ms
Interruptions: 4
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/cbf45e49-1a7e-4531-ad29-a0a37e6878da_20250403T17:25_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I, I just wanted to inquire the benefits information, uh, for this patient please.
[AGENT][NEUTRAL] OK, [PII], you're needing benefit information only, is that correct? or do you also need eligibility as well?
[CUSTOMER][NEUTRAL] Um, I would say both just to be safe.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I can help you with that, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] And you can be
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Uh, one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, OK, it's 019882.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 39 M like Mary L like Larry 8.
[AGENT][NEUTRAL] OK, thank you. One moment while I get some emer information pulled up please.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] That was their thing. The one at clinic, he's trying to establish this EOE clinic.
[CUSTOMER][NEGATIVE] It's not really working.
[CUSTOMER][NEUTRAL] Yeah, that's what we found down here down south there's like no center.
[CUSTOMER][NEUTRAL] Where
[CUSTOMER][NEUTRAL] like there's like the pediatric.
[CUSTOMER][NEUTRAL] Up in um [PII]
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Like I, I mean, I have a lot too.
[CUSTOMER][NEUTRAL] Nothing
[CUSTOMER][NEUTRAL] Uh, so I'm, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show he is a dependent on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need, [PII] inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office please for a specialist.
[AGENT][NEUTRAL] OK, so under the supplemental policy, office visits are not covered?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] However, if he were to receive some form of treatment in the office, that could be reviewed under the outpatient benefit.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the outpatient benefit maximum per calendar day for covered outpatient services is $500.
[CUSTOMER][NEUTRAL] bring
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] And with this being a supplemental policy, [PII] to the primary insurance, when the claims are submitted to APO for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And once we have processed our claim, we have a portal in which you should be able to check our claim status.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] OK OK.
[AGENT][POSITIVE] And the website for our portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] This all this is like all.
[CUSTOMER][POSITIVE] Take care, thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK, um, so since you said that, um, sorry, backtracking since you said that it was a cap of $500 per day, um, that means that.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We covered outpatient services.
[CUSTOMER][NEUTRAL] Oh, OK, cause this patient right now, um, going based off the primary insurance.
[CUSTOMER][NEUTRAL] Oh, OK, well, go just for future going based off the primary insurance, he has to pay like a $55 copay. Would you guys cover that or would you?
[CUSTOMER][NEUTRAL] Um, is the patient responsible for that?
[AGENT][NEUTRAL] Again.
[AGENT][NEUTRAL] Under this policy, office visits are not covered.
[AGENT][NEUTRAL] But we could review treatment in the office under that outpatient benefit that I gave you.
[AGENT][NEUTRAL] But the office visit is not something this policy would cover.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I think I got everything that I needed. Can I get the reference number please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date. And again, my name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] Well, you're welcome. And again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that'll be all thank you.
[AGENT][POSITIVE] Well, you're welcome and thank you for calling APL. I hope you have a great afternoon, [PII].
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you. Bye