AccountId: 011433970860
ContactId: cfadea1c-62f0-4808-87d2-d4807f30741d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400279 ms
Total Talk Time (AGENT): 139794 ms
Total Talk Time (CUSTOMER): 173600 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/cfadea1c-62f0-4808-87d2-d4807f30741d_20250321T20:06_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling in regards to verification.
[CUSTOMER][POSITIVE] Of benefits
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and the benefits. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] On the card, uh, I'm the member. On the card, I see a payer ID.
[CUSTOMER][NEUTRAL] Um, a group number and a certification number. Which one of these?
[AGENT][NEUTRAL] The certification number.
[CUSTOMER][NEUTRAL] 02363893 M as in Mary, L as in Lamp 8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And I have you here and [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I don't know which email you have on file since this is through my employer, but um.
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][POSITIVE] Thank you for that and the email looks like it is your work email.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And you said you wanted to verify the insurance, like do you want to see if it's active or?
[CUSTOMER][NEUTRAL] Yes, it's, uh, so, um, this year, the first year, which was [PII] coverage, I received the card for this um for this year, I did not receive any cards, so I'm confirming if the information is still the same and active.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, yes, ma'am. The information is still the same. Um there's been no changes. We don't send out cards every year, so you won't receive a card, but everything is still the same.
[CUSTOMER][NEUTRAL] OK, and it's active, right?
[AGENT][NEUTRAL] Yes, ma'am. Your policy is active.
[CUSTOMER][NEUTRAL] Uh, question for you. So this supplemental coverage, um, covers the gap for my deductible for my primary insurance, right?
[AGENT][NEUTRAL] So we pay towards your co-pay, deductible or co-insurance after primary insurance of covered charges. So it can be like inpatient or outpatient. You have a, um, let me see if your calendar year. You have a max that you can use for those expenses and like if you pay a deductible.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Right. Um, does that include just regular office co-pay? Let's say I have, um, let's say I pay $25 for an office visit. Can I submit a claim to cover that co-pay or no?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if you have office visits. Hold on one moment. Let me pull up your benefits.
[AGENT][NEUTRAL] I just wanna make sure.
[AGENT][NEUTRAL] So yeah, under outpatient for your policy, there's no, there's no coverage for the in-office setting. Um, so your secondary policy covers in hospitals and then outpatient like the emergency room, urgent care, if you were to have any outpatient surgeries, um, even if you do like.
[CUSTOMER][NEUTRAL] OK. The outpatient portion of it, does that cover, let's say, procedures like MRI that's, you know, is not covered?
[AGENT][NEUTRAL] Yes, I was gonna say
[CUSTOMER][NEUTRAL] Through the primary.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] So it's not if it's in the primary facility. If it's in an outpatient facility, yes, you can use your secondary, but anything in office, it wouldn't cover.
[CUSTOMER][NEUTRAL] Outpatient. OK.
[CUSTOMER][POSITIVE] Got it. So, um, that's great that you confirmed because I remember using my supplemental this APL and back in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you recall which
[CUSTOMER][NEUTRAL] I don't know if you can go back and look at the claims. It was an MRI.
[AGENT][NEUTRAL] You said in [PII]?
[CUSTOMER][NEUTRAL] [PII]. Do you see a claim for that? I can give you the uh name of the facility. It was an outpatient.
[CUSTOMER][NEUTRAL] Uh, settings. I provided them my
[AGENT][NEUTRAL] Do you have the data service?
[CUSTOMER][NEUTRAL] I can look for it, yes, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a minute.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's just they keep on sending me invoices, uh, even though they confirmed that everything is covered, so I'm.
[CUSTOMER][NEUTRAL] Let me just go back to the previous calendar here.
[CUSTOMER][NEUTRAL] OK. I believe it was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], we don't have any claims on file for you for that date.
[AGENT][NEUTRAL] We really, so.
[CUSTOMER][NEUTRAL] OK, so they, they never submitted it.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what is the, is that claim to let's say if I call them and you know I tell them that this claim was not submitted, do they still have time to submit it because I don't wanna be financially responsible if they failed to submit a claim when I provided them that information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. So yes, we don't have a timely filing limit. So yes, you can give them a call and let them know as long as the policy was active on the data service, you can file a claim at any time.
[CUSTOMER][POSITIVE] OK, and it was active. You can see that uh at that time I have leverage. OK, thank you so much for your help.
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all have a good day.
[AGENT][POSITIVE] Alright, thanks for calling API have a great weekend bye bye.