AccountId: 011433970860
ContactId: d376d68e-e605-4af2-90f2-44096245c707
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323859 ms
Total Talk Time (AGENT): 140441 ms
Total Talk Time (CUSTOMER): 81661 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/d376d68e-e605-4af2-90f2-44096245c707_20250516T13:46_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] Yeah, hello [PII].
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello? Can you hear me?
[AGENT][NEUTRAL] I can hear you now, yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, yeah, hi, this is [PII]. I'm calling from Provida's office. I need to check eligibility and benefits for a mutual patient.
[AGENT][NEUTRAL] OK. And did you, what, what is your first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, [PII], I can help you. What are you said that you're needing eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yeah, yes, right.
[AGENT][NEUTRAL] Yes, I can help you with that, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] A call back number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02042058 M as in Mary, L as in Lima, 8.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And any information [PII] that is provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient first name is [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show that he is a dependent on the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's uh outpatient.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] A specialized office visit copay.
[AGENT][NEUTRAL] OK, office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] For specialized office visit benefit.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Not covered?
[AGENT][NEUTRAL] If they should receive some form of treatment in the office, we could review the office under their outpatient benefit maximum, and the outpatient benefit maximum per calendar year for covered outpatient services is $1500 with no outpatient deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] However, again, the office visit.
[CUSTOMER][NEUTRAL] OK, it's covered 100% ma'am, right?
[AGENT][NEUTRAL] But office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] If you do end up filing a claim for this number with APL, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] For review
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL, Glen, we have a portal in which you can check claim status by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK, this patient is required any a referral or what?
[AGENT][NEUTRAL] Did you ask if a referral was needed? Is that correct?
[CUSTOMER][NEUTRAL] Yes, this patient is required.
[AGENT][NEUTRAL] It is not required on the supplemental policy.
[CUSTOMER][NEUTRAL] OK. So for office visit is, it's not covered, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, can I get the call reference number for this call?
[AGENT][NEUTRAL] It would be my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Yeah, OK, thank you, [PII], for assisting this wonderful information today. Have a great day and happy weekend.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][POSITIVE] Yes. [PII]. Well, you're very welcome. I, I hope you have a nice weekend as well, and thank you again for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.