AccountId: 011433970860
ContactId: d83514a3-9d07-4749-9103-47a226c9abde
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283720 ms
Total Talk Time (AGENT): 141726 ms
Total Talk Time (CUSTOMER): 101887 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/d83514a3-9d07-4749-9103-47a226c9abde_20250310T12:08_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]. Yes, I'm calling because I need to verify coverage for a patient, please.
[AGENT][NEUTRAL] OK. Do you need to just verify eligibility or do you need eligibility and benefit information?
[CUSTOMER][NEUTRAL] Both eligibility and benefits.
[AGENT][POSITIVE] Yes, ma'am, I can help you. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and that's a direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Policy number is 02603933.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][POSITIVE] Good morning
[AGENT][NEUTRAL] And [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] I have here [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because I sent another email so I have 3, I had 4.
[CUSTOMER][NEUTRAL] This is ordered by the cardiologist the cardiologist.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, that's what we do. That's upstairs, OK, so this insurance is co-payment only charge for.
[CUSTOMER][NEUTRAL] Would it be is it the basic?
[AGENT][NEUTRAL] OK, so I do see she is the subscriber on the supplemental policy, Alexis, and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 35? No.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient she's gonna be having outpatient surgery with us today.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] This goes with the 350 and the basic OK so it goes like this.
[CUSTOMER][NEUTRAL] 35.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Just to make
[AGENT][NEUTRAL] OK, so she has an outpatient benefit mark per calendar year of.
[CUSTOMER][NEUTRAL] So this is
[AGENT][NEUTRAL] Well, I'm sorry, I just lost my information. I was about to give you a $3000.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Per covered person for covered outpatient services, and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] I'm sorry, it kind of cut off so what's the max that you guys uh pay for for these services?
[AGENT][NEUTRAL] The outpatient benefit maximum on this policy is $3000 per calendar year for covered outpatient services with no outpatient deductible and Alexis because this is a supplemental policy.
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] To a primary when the claim is submitted to APL, we will also have to have a copy of her primary insurance company's outpatient, um, excuse me, her primary insurance explanation of benefits as well. And then once we have processed our claim, we do have a.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Portals that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes ma'am, can you hear me?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, yeah, it just keeps going in and out, but I did hear you. I, I was just wondering, um, has she met anything towards that $3000?
[CUSTOMER][NEUTRAL] Has she used anything I should say actually.
[AGENT][NEUTRAL] Just one moment. For this, no, ma'am, she has not. As of now, no, ma'am.
[CUSTOMER][POSITIVE] As of now there's no claims. OK, perfect, so she still has the $3000 available.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] As of now, she does. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK perfect thank you so much and [PII], can you provide me with the reference number for the call or just your name and today's date?
[AGENT][NEUTRAL] Yes, you, yes, ma'am it's my name and today's date.
[CUSTOMER][NEUTRAL] OK, and the first initial to your last name?
[AGENT][NEUTRAL] [PII]. And is there anything else, [PII] I can help you with today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No that was all thank you so much have a great day.
[AGENT][POSITIVE] Well, you're very welcome and thank you for calling APL. I hope you have a great day as well.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] Bye-bye.