AccountId: 011433970860
ContactId: d86de0fd-3716-4547-af90-33dd351495ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297799 ms
Total Talk Time (AGENT): 148036 ms
Total Talk Time (CUSTOMER): 109306 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/d86de0fd-3716-4547-af90-33dd351495ef_20250122T20:24_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I am calling to check uh eligibility and benefits.
[AGENT][NEUTRAL] OK, you need excuse me, eligibility and benefits for a member, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from Orthopedic Center of South Florida.
[AGENT][NEUTRAL] Thank you, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 01699430. M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you, one moment please while I get the member's information loaded.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and where was this gonna be for a future data service?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, and any information that I do 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] Mhm.
[CUSTOMER][NEUTRAL] [PII], uh, date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. So I'm going to give you an updated policy number. That policy number you gave me is old and it's um no longer active.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] The current active policy number for her is going to be 2472991.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is active and the supplemental policy has an effective date of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information are you needing for her today, Will inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Did she has.
[CUSTOMER][NEUTRAL] Uh, this is, this is gonna be for an outpatient, but it's actually easier than that. Did the patient has any type of deductibles?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this policy is a supplemental policy to her primary insurance. We are not a major medical carrier.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][POSITIVE] Perfect. And do you guys pay the primary deductible?
[AGENT][NEUTRAL] This policy is designed to help with the co-pays, deductibles, and co-insurance amounts of coverage services. So on this policy, the outpatient benefit maximum is $300.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Per calendar day for covered outpatient services and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And then when the claim, mhm, go ahead with your question.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, because that that definition kind of confused me so because I'm running the bill with the insurance company because she wants to know if she has to pay anything. Her primary insurance, her primary insurance says that she will be responsible for uh $2300 deductible.
[AGENT][NEUTRAL] And we can
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if we send that to you guys, you only pay $300?
[AGENT][NEUTRAL] The maximum outpatient benefit, yes sir, per calendar day on this plan is $300.
[CUSTOMER][POSITIVE] Got it. OK, perfect.
[AGENT][NEUTRAL] For covered outpatient services, yes, and when the claim is submitted will to APL for our review, we must also have a copy of our primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, correct, alright.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal in which you can check claim status and have access to the our EOBs and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] Got it. And the last question that I have is, are these benefits paid directly to the provider or to the member?
[AGENT][NEUTRAL] Whomever files the claim?
[CUSTOMER][POSITIVE] OK, that will be us. Alright, perfect. That is basically it. Thank you so much for your time and have a beautiful day.
[AGENT][POSITIVE] Well, well, I hope you have a wonderful day too, Will, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Have a good one bye bye.
[AGENT][NEUTRAL] You too. Bye bye.