AccountId: 011433970860
ContactId: d62ffb65-e5bd-491b-827b-5a46f974fe39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 575700 ms
Total Talk Time (AGENT): 250717 ms
Total Talk Time (CUSTOMER): 117032 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/d62ffb65-e5bd-491b-827b-5a46f974fe39_20250124T19:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, good afternoon, [PII]. I'm calling to get eligibility and benefits for 2 patients.
[AGENT][NEUTRAL] OK, so you need eligibility and benefit information for two separate members, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, my name is [PII].
[AGENT][NEUTRAL] Can you spell your name for me please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, and the first member's policy number, please.
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] Policy number?
[CUSTOMER][NEUTRAL] 02509836
[AGENT][NEUTRAL] OK, one moment for me to get the member's information pulled up and that you will use my name that I gave you along with today's date as your call reference number for each patient and then also any information that is provided will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] [PII], how do you spell your name? Is it [PII]?
[AGENT][NEUTRAL] No, ma'am. It's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Uh correct.
[CUSTOMER][NEUTRAL] Uh, first letter of your last name, please.
[AGENT][NEUTRAL] [PII] and yours?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], also, uh, on this, well, I'll give you that information in a moment, just one second.
[AGENT][NEUTRAL] OK, and again, any information that I provide for you on either policy will be a verification of benefits and not a guarantee of payment. On this policy, what is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So she, I do show that she is a dependent on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need and pay?
[CUSTOMER][NEUTRAL] Can you please repeat what you said?
[AGENT][NEUTRAL] The supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] When is
[CUSTOMER][NEUTRAL] Got it. And
[CUSTOMER][NEUTRAL] Is there like an outpatient benefit maximum? Does it follow Medicare guidelines?
[AGENT][NEUTRAL] Yes, and that's what I have.
[AGENT][NEUTRAL] No ma'am, it does not follow Medicare guidelines. This is a supplemental policy only that follows her major medical insurance. The outpatient benefit maximum on this supplemental policy for covered outpatient services is $8700 with no outpatient deductible.
[CUSTOMER][NEUTRAL] That's not.
[CUSTOMER][NEUTRAL] $8700. Um, has
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Is it, is there like a, what's the accumulation?
[AGENT][NEUTRAL] This is a supplemental policy only to her primary health care insurance. We are not a major medical carrier.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, I am here.
[CUSTOMER][NEUTRAL] What's the accumulation?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] So just one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Of office visit is not covered, right? Because this is just for major outpatient.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Office visits are not covered. Office visits charges are not covered under the supplemental policy. We can review treatment within the office, but the office visit itself is not covered.
[CUSTOMER][NEUTRAL] Um, procedures.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Uh just a moment while it's still loading some information.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And you are inquiring about accumulations for this calendar year, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] As of now, there have not been any benefits used for this calendar year.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Can we move to the next patient?
[AGENT][NEUTRAL] Uh, no, ma'am, not yet. I'm gonna need to finish my portion of this call on this member's policy first and then we can move on. Now, also, in addition, there's a couple of other things that I needed to tell you on this type of policy because it is a supplement to her primary healthcare insurance.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] We will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then if you do submit a claim to APL once we have reviewed it, we do have a portal reason that you should be able to check our claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And again on this policy, the maximum outpatient benefit per calendar year per covered person for covered outpatient services was.
[AGENT][NEUTRAL] 8700 with no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is your next patient's policy number, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 01807300 Mama Lima 8.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, and same with this one, any information 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] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so she had been a subscriber on this policy, but this policy is no longer active. This policy was active from [PII] to its term date of [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] She did have other coverage with APO after that. However, she has not had any coverage with our company since [PII].
[CUSTOMER][POSITIVE] Got it, got it.
[CUSTOMER][POSITIVE] All right. I'm gonna deactivate the patient's plan now. Um, I think I'm all good. Thank you so much, [PII].
[AGENT][POSITIVE] OK, well, you are very welcome. So if that's all the reasons that I can help you with today. Thank you for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Um bye bye.
[CUSTOMER][NEUTRAL] I'll go in.