AccountId: 011433970860
ContactId: dd09667c-5f21-467c-862a-9aacec7a222c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292720 ms
Total Talk Time (AGENT): 142000 ms
Total Talk Time (CUSTOMER): 97551 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/dd09667c-5f21-467c-862a-9aacec7a222c_20250106T14:04_UTC.wav
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[AGENT][NEUTRAL] Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII] and I'm calling with Gastro Health. I'd like to know um if this secondary insurance is active for a patient who's here for an appointment today.
[AGENT][NEUTRAL] OK, [PII], all you're needing to know if for a policy is active, is that correct?
[CUSTOMER][POSITIVE] I'm sorry, can you repeat that? I'm so sorry.
[AGENT][NEUTRAL] Is the only thing that you need to know is whether a policy is active or not. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am mhm.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is a good callback number for you please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Is it the in hospitals benefit number?
[AGENT][NEUTRAL] Yes, and you can give me either one of those 2 numbers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02563062
[CUSTOMER][NEUTRAL] M for Mary, L for Larry 7.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], 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 their date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So she is uh the spouse of the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when the claim is submitted to APL for review, we will have to have a copy of the primary insurance company's explanation of benefits as well for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then also we do have a portal. Oh, I'm sorry, go ahead.
[CUSTOMER][POSITIVE] Thank you and I have a ques.
[CUSTOMER][NEUTRAL] I'm sorry, no, no, go ahead.
[AGENT][NEUTRAL] I was gonna say, and we also have a portal in which you can check claim status and have access to the EOB and that portal is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said that you had another question?
[CUSTOMER][POSITIVE] Perfect, OK.
[CUSTOMER][NEUTRAL] Yes, so when it comes to this insurance, um, do they pay their out of pocket with their primary insurance? or do you guys cover their out of, um, I'm sorry, their copay, their office copay?
[AGENT][NEUTRAL] Again
[AGENT][NEUTRAL] Let me look at her benefits again, I can't guarantee payment of any claim. I can only provide the benefits to you on the policy. Um, just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're calling for an office visit, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am mhm.
[AGENT][NEUTRAL] OK, let me look to see if office visit.
[AGENT][NEUTRAL] They're covered.
[AGENT][NEUTRAL] Under this supplemental policy.
[CUSTOMER][NEUTRAL] Sea Pineda.
[AGENT][NEUTRAL] OK, under this supplemental policy, [PII] office visits are not a covered benefit.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Got it perfect.
[CUSTOMER][NEUTRAL] OK, and I'm so sorry, one last question, um, how much do they have under this plan like under their insurance, like how much do you guys cover?
[AGENT][NEUTRAL] For covered outpatients.
[CUSTOMER][NEUTRAL] For like any procedures for anything, yeah.
[AGENT][NEUTRAL] Well, nothing in the offices office procedures and office visits are not covered, but for covered outpatient services, the outpatient benefit maximum is $2000 per covered person per calendar year, and there is no deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK, thank you so much, ma'am. Is there a reference number to this call?
[AGENT][NEUTRAL] Yes, ma'am. It will be my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII] you have a great rest of your day.
[AGENT][POSITIVE] I hope you have a great day too, [PII], if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.