AccountId: 011433970860
ContactId: cd186016-eef7-4308-a873-84c78635edf0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 145210 ms
Total Talk Time (AGENT): 72789 ms
Total Talk Time (CUSTOMER): 68206 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/cd186016-eef7-4308-a873-84c78635edf0_20250122T21:51_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling to check, um benefits or I guess however the supplement works. Um, I have a patient coming in for a surgical procedure tomorrow and um she told me today that she has this uh supplement, which is wonderful, um, but I was just wondering if I could get a little more information. She was able to send me a copy of the card, so I have all that information. I just didn't know if it works like a secondary insurance where we just submit.
[CUSTOMER][NEUTRAL] You know, we submit to Aetna, her primary, and then our billing company would just submit to the secondary.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK. And now I need the member's policy number.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Um, her policy
[CUSTOMER][NEUTRAL] Sure, it is
[CUSTOMER][NEUTRAL] 0254.
[CUSTOMER][NEUTRAL] 5403.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh huh, [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And this surgery, will it take place in office or in an outpatient facility?
[CUSTOMER][NEUTRAL] Outpatient facility.
[AGENT][NEUTRAL] OK, for outpatient services under this policy, we cover up to 3500 per calendar year and that's for the copay, the co-insurance, and the deductible after the primary insurance processes the claim. And what normally happens is that the provider will file the claim with the primary insurance company first and then the provider will um file a claim with us along with the EOB from the primary insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] Perfect. Sounds good. That is what I wanted to hear. Awesome. OK, well thank you so much. um, that's really all I needed and you said it was EV or AV?
[AGENT][NEUTRAL] Um, it's Evi. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Nope, that is it.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Mm, thank you.