AccountId: 011433970860
ContactId: d000707b-7287-4a04-a412-d09b478dd247
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261369 ms
Total Talk Time (AGENT): 132950 ms
Total Talk Time (CUSTOMER): 90315 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/d000707b-7287-4a04-a412-d09b478dd247_20250212T13:10_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Hi [PII]. My name is [PII]. Last name and it's show C for Charlie. I'm calling on behalf of a patient to see her eligibility status with you guys.
[AGENT][NEUTRAL] OK. You said, did you say that your name was [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am mhm.
[AGENT][NEUTRAL] OK, all right, [PII], and you're just needing to check eligibility, you're not needing benefit information, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that, and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Yes, it's gonna be 1480051.
[CUSTOMER][NEUTRAL] M as in Mary.
[CUSTOMER][NEUTRAL] L as in Lima.
[CUSTOMER][NEUTRAL] And the number 8.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], any information 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 please and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is a subscriber, [PII] on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], because this is a supplemental policy, if you all will be filing a claim with APL for review, we must also receive a copy of her primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then lastly we do have a portal here at APL that you should be able to check claim status and have access to our EOB once we've processed our claim and our portal website for that is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect and um just one more quick question.
[CUSTOMER][NEUTRAL] Um, because I'm looking back at previous notes.
[CUSTOMER][NEUTRAL] Because she's this is the OBGYN office, the specialist, and the previous notes are saying that office visits are not covered, so I just kind of wanted to see.
[AGENT][NEUTRAL] That is correct. Office visits are not covered.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, office visits are not covered.
[AGENT][NEUTRAL] She, mhm.
[CUSTOMER][NEUTRAL] OK, so she's act.
[AGENT][NEUTRAL] She does have, oh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] No, um, go ahead, say what you were gonna say.
[AGENT][NEUTRAL] OK, so she does have an office treatment writer on this policy in which we could review treatment that's rendered within the office under her outpatient benefit maximum, but office visits are not covered.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] Because she's coming in for um a bone density.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Does she have any type of coverage for that?
[AGENT][NEUTRAL] So her outpatient benefit maximum per calendar year for covered outpatient services is $3000 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so you get the plan, um, or the policy pays up to 3000, the max benefit for outpatients.
[AGENT][NEUTRAL] For covered, for covered, mhm, for outpatient covered services.
[CUSTOMER][NEUTRAL] Outpatient coverage services, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sounds good and can I just get your name and a reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, my name is [PII], and you would use my name along with today's date as your call reference number, [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] All right. Well, you're very welcome. And is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that'll be it thank you [PII].
[AGENT][POSITIVE] Well, you're welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.