AccountId: 011433970860
ContactId: d98b9995-0279-4b8f-90cc-fc89a71a7c9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409799 ms
Total Talk Time (AGENT): 173506 ms
Total Talk Time (CUSTOMER): 133461 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/d98b9995-0279-4b8f-90cc-fc89a71a7c9b_20250121T13:09_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] Uh, yes, so, uh, my name is [PII], and I'm calling from a provider just trying to get someone's gap insurance benefits verified.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, I can help you with those things, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, yes, their policy number is.
[CUSTOMER][NEUTRAL] Uh, do I give you, um, outpatient benefits certificate cer uh number?
[AGENT][NEUTRAL] That will be fine, yes.
[CUSTOMER][NEUTRAL] Alright, so it looks like 1105.
[CUSTOMER][NEUTRAL] 206 M as in Mary, L as in Larry 5.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] OK just one moment.
[CUSTOMER][POSITIVE] Good morning. Be with you in just a few minutes. Thank you.
[CUSTOMER][NEUTRAL] Yeah
[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] Uh yes. Uh patient's name is [PII] Last name [PII]
[CUSTOMER][NEUTRAL] And her date of birth is.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you. Now, the policy number that you gave me is an old policy that's no longer active. She does have a, a policy that is active with a different number. The policy number you gave me term date [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And her currently active policy is 0180.
[CUSTOMER][NEUTRAL] If you could give me the current policy number.
[AGENT][NEUTRAL] 7114.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[AGENT][NEUTRAL] And again, that one is still active. So just one moment for me to get that information pulled up. You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, and [PII], she is a subscriber on the supplemental policy?
[AGENT][NEUTRAL] And what type of benefit information are you needing today? Inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] Uh, outpatient ambulatory benefits.
[AGENT][NEUTRAL] OK, and any information again that I do provide will be a verification of benefits and not a guarantee of payment. So on the supplemental policy, [PII], for outpatient benefits, maximum per calendar year for covered outpatient services is $1000.
[AGENT][NEUTRAL] And there is no outpatient deductible.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And because this is a supplemental plan added to her primary insurance, we will have to also receive a copy of her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal in which claim status should be able to be checked and also have access to our EOB and our portal website is [PII].
[CUSTOMER][NEUTRAL] OK, um, do you mind if I place you on a brief hold?
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][POSITIVE] Thank you, I'll be as quick as possible.
[AGENT][NEUTRAL] Oh, you're, you're fine.
[CUSTOMER][NEUTRAL] So out of her $1000 maximum, like how much of that has been satisfied?
[AGENT][NEUTRAL] I can check to see as of now she's used anything. One moment.
[AGENT][NEGATIVE] For this calendar year, as of now, there has not been any benefits used.
[CUSTOMER][NEUTRAL] OK, all right, can I place you on one more hold?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Hello, good morning.
[AGENT][NEUTRAL] Mhm. I'm sorry, I was taking a sip of my cover. Good morning.
[CUSTOMER][NEUTRAL] So when you said $1000 so the patient, I'm sorry, good morning. So I just wanna make sure I'm understanding you right. So the lady, she has $1000 that she can use towards her bill, but she hasn't met any of the thousands of $1000 still remaining, correct?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] As of now she is
[CUSTOMER][NEUTRAL] That you guys will cover.
[AGENT][NEUTRAL] I can't, as I explained to [PII], I cannot guarantee payment. I'm only able to verify the benefits, and that is correct. She has not used any of her outpatient benefits as of now for this calendar year. Yes, ma'am.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so we'll apply that 1000 to there and then she'll just pay us the remaining of the what is it 16, so she owe us 600.
[CUSTOMER][POSITIVE] She owe you 600. OK, alright, thank you. You got an effective date.
[AGENT][POSITIVE] Well, you're welcome.
[CUSTOMER][NEUTRAL] OK, and a reference number? Can I get a reference number?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] What is your name again?
[AGENT][NEUTRAL] [PII] and yours?
[CUSTOMER][NEUTRAL] [PII] and what is it? [PII], yeah, alright, thank you.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][POSITIVE] Mhm. OK, well, thank you very much.
[CUSTOMER][NEUTRAL] Mhm.