AccountId: 011433970860
ContactId: d0134327-cdfd-4c8e-a965-eefcc903d9a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241880 ms
Total Talk Time (AGENT): 123502 ms
Total Talk Time (CUSTOMER): 84521 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/d0134327-cdfd-4c8e-a965-eefcc903d9a6_20250529T13:04_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] Um, hi, Ms. [PII]. My name is [PII]. I'm calling from, um, West Balkha Medical Center. I'm just checking to verify if benefits are active.
[AGENT][NEUTRAL] OK, so you're just needing to verify if the member has active coverage with APL Sandra, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII], which is a direct number.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Uh, the member's policy number is 024.
[CUSTOMER][NEUTRAL] 73375 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is.
[CUSTOMER][NEUTRAL] I'm gonna spell the first name, [PII] Last name is [PII] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So again, any information provided would be a verification of benefits and not a guarantee of payment. I do show that she is the subscriber on this supplemental policy and yes ma'am, it is active with an effective date of [PII].
[AGENT][NEUTRAL] And [PII], if there's a way that you can make a note of this, should you will file a claim with APO for this number when the claim is submitted to us, we will have to have a copy of her primary insurance company's explanation of benefits as well for review.
[AGENT][NEUTRAL] And then once we have processed our claim here at APO we do have a portal.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And which you all should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Uh-huh.
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] With a D on it, make sure to put a D [PII].
[CUSTOMER][POSITIVE] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK. Um, now, how do I find out if, cause I know this is a secondary insurance, how do I find out if an authorization is required?
[AGENT][NEUTRAL] For the supplemental policy.
[CUSTOMER][NEUTRAL] Or referral is required for a procedure.
[AGENT][NEUTRAL] For the supplemental policy, there is no prior authorization and no referral. This would follow her primary insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so with, but with billing you guys will also need a copy of the uh explanation of benefits from uh for the Blue Cross as well.
[AGENT][NEUTRAL] That is correct. Yes, because this policy helps with co-pays, deductibles, uh high and co-insurance amounts of coverage services. So yes, we do have to receive the primary EOB with the claim.
[CUSTOMER][NEUTRAL] OK, just wanted to make sure.
[CUSTOMER][NEUTRAL] Got you OK and do you guys offer reference numbers?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] All right, Ms. [PII]. Thank you so very much. You've been so kind. I appreciate your help and you have a great rest of your day.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][POSITIVE] Oh, you're certainly very welcome.
[AGENT][POSITIVE] I hope you have a great day too, [PII], and if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you. Mm bye-bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.