AccountId: 011433970860
ContactId: d298abe5-7f5f-488b-b06f-41340f1ad816
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 348029 ms
Total Talk Time (AGENT): 158395 ms
Total Talk Time (CUSTOMER): 86132 ms
Interruptions: 3
Overall Sentiment: AGENT=1.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/d298abe5-7f5f-488b-b06f-41340f1ad816_20250124T19:59_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, good afternoon, [PII]. My name is [PII]. I'm calling from Minors Dermatology. I was trying to get benefits and eligibility on a mutual patient.
[AGENT][NEUTRAL] OK, [PII], you're needing benefits and eligibility. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. All right, give me just one moment.
[AGENT][NEUTRAL] And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] OK, give me just one moment, um.
[CUSTOMER][POSITIVE] No problem thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] in the
[AGENT][NEUTRAL] OK, and what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] It's gonna be 02518146.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] So cute.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] I mean you see calls like this.
[CUSTOMER][NEUTRAL] My patient's first name is [PII], patient's last name is [PII], and their date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So what I'm
[CUSTOMER][NEUTRAL] um.
[AGENT][NEUTRAL] OK, so I did show that he is a subscriber, [PII], on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] So inpatient um in network for specialists.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] In hospital admission, inpatient? Is that what you said?
[CUSTOMER][NEUTRAL] Um, like medical and office for specialists, yes, yes.
[AGENT][NEUTRAL] OK, for an office visit?
[AGENT][NEUTRAL] OK, office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] However, if they were to receive some type of treatment rendered within the office, then that is something that could be reviewed under this supplemental policy.
[AGENT][NEUTRAL] And the outpatient benefit max for covered outpatient services is $2,025. Uh, give me, well, actually give me just one second. It's still trying to lay a piece of information for me, [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No problem. You said 2000.
[AGENT][NEUTRAL] No, give me just a moment to verify that, OK? One moment.
[AGENT][NEUTRAL] Yes, OK, so on the policy, yes, the outpatient benefit max per covered person for covered outpatient services is 20225, 2025.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if you all do submit.
[CUSTOMER][NEUTRAL] And that's for procedures outpatient.
[AGENT][MIXED] Correct, but the office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you all do file a claim with us for him, [PII], then we would also have to have a copy of his primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] As well for review and then once we have processed our claim we do have a portal in which you should be able to check claim status and our portal website is located at secured.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Alrighty, my dear, and if I can just get again your name and a reference number for this verification.
[AGENT][NEUTRAL] Again, my name is [PII] and my name along with today's date would be your call reference number.
[CUSTOMER][POSITIVE] Perfect [PII] I appreciate your help thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that's all then that I can help you with, thank you again for calling APL and I hope that you have a very nice weekend.
[CUSTOMER][POSITIVE] Thank you. You as well. Take care.
[AGENT][POSITIVE] Yes, ma'am. Thank you. You too. Bye-bye.