AccountId: 011433970860
ContactId: cc6d6617-f1b1-4022-96b7-0c2d7399d492
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 305589 ms
Total Talk Time (AGENT): 156804 ms
Total Talk Time (CUSTOMER): 88725 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/cc6d6617-f1b1-4022-96b7-0c2d7399d492_20250129T16:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Good morning. Um, I was needing to verify benefits on a patient.
[AGENT][NEUTRAL] All right, you're needing to verify benefits, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] 02260174
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And [PII], any information that I do 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, please?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] All right, thank you. One moment.
[AGENT][NEUTRAL] OK, so I do show that Mr. [PII] is a subscriber on this supplemental policy, and this supplemental policy, [PII] is effective [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, office, I was checking on a specialist office visit and then outpatient, I was checking on, um, if there was any coverage for a colonoscopy screening or diagnostic outpatient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so under this supplemental policy office visits are not covered?
[AGENT][NEUTRAL] We can review under his outpatient benefits for his diagnostic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Test and his outpatient benefit maximum per calendar year for covered outpatient services is $5000.
[AGENT][NEUTRAL] And there is also a $250 outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, has he used that yet?
[CUSTOMER][NEUTRAL] Has he met that?
[AGENT][NEUTRAL] For this calendar year, is that correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, I can check for you. Just one moment.
[AGENT][NEUTRAL] And as of now, no ma'am, he has not used any benefits for this calendar year mhm and because this is a go ahead.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, is there a
[CUSTOMER][NEUTRAL] Go ahead. I'm sorry.
[AGENT][NEUTRAL] I was gonna say
[CUSTOMER][NEUTRAL] I mean, is there a co-insurance on the plan or?
[AGENT][NEUTRAL] This is, we're not a major medical insurance. This is his supplemental policy to his primary.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So once he meets that $250 deductible, then y'all will pay up to 5000, is that correct?
[AGENT][NEUTRAL] For covered outpatient services.
[CUSTOMER][NEUTRAL] OK. Is colonoscopy covered?
[AGENT][NEUTRAL] We would have to we can't pay claims over the phone, [PII]. We would have to receive the claim along with his primary insurance company's detailed explanation of benefits. This plan helps him with any co-pays, deductibles or co-insurance amounts.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of covered services.
[CUSTOMER][NEUTRAL] All right, any kind of referral, anything like that needed? No, on this type of policy?
[AGENT][NEUTRAL] No, there's no prior authorization, correct, no prior authorization is required. There's not a network affiliated with this policy. It all follows as primary insurance.
[CUSTOMER][NEUTRAL] OK, um, no screening benefits, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Same thing, just at [PII]. OK. Yeah, see that.
[CUSTOMER][NEUTRAL] Well we collect everything up front before we even put him on the schedule, so we'll pretend like he didn't even have this and then go from there. OK, do you give a reference number?
[AGENT][NEUTRAL] Uh, yes, you would use my name that I gave you, [PII], first initial to last name [PII]
[AGENT][NEUTRAL] And then once the claim has been processed with APO if you all do file that you should be able to check claim status in our portal [PII] by going to [PII].
[CUSTOMER][POSITIVE] OK, all right, thank you.
[AGENT][POSITIVE] OK. All right. Well, if that's all then that I can help you with, thank you again for calling APL and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] Bye-bye.