AccountId: 011433970860
ContactId: dd2b67bb-9469-4f18-824a-94fe085000a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 561950 ms
Total Talk Time (AGENT): 207206 ms
Total Talk Time (CUSTOMER): 175542 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/dd2b67bb-9469-4f18-824a-94fe085000a7_20250228T16:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? I'm sorry, I didn't catch your name?
[AGENT][NEUTRAL] My name is [PII] and how are you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. My name is [PII]. I'm calling to check up benefits for uh one member.
[AGENT][NEUTRAL] OK, I can assist with benefits, [PII], before we get started, may I have your callback number if we are disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you very much and what is the policy number please for the patient?
[CUSTOMER][NEUTRAL] would be 02269879 and [PII] and a number.
[AGENT][NEUTRAL] OK, I have that as 02269879 ML 8.
[AGENT][NEUTRAL] One moment please thank you verify the patient's name and date of birth.
[CUSTOMER][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you very much for the information. I have it pulled up and you're calling for benefits for outpatient. Give me one moment. I can certainly help you with that.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Please note verification of benefits provided that not guaranteed payment. We pay up to $250 per calendar day. Again, this is a per day max of up to $250.
[CUSTOMER][NEUTRAL] OK. Just uh uh we'd like to know because we send a claim to see if you cover co-payment. The patient is responsible for $15. It was for office visit. So I want to make sure if you cover because we send this claim, let me tell you when.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And we didn't receive a response for you, so I want to make sure if the member have benefits for office visit co-payment.
[AGENT][NEUTRAL] What is the date of service and the total charge amount please?
[CUSTOMER][NEUTRAL] Uh, [PII], you need what we sent or the total amount?
[AGENT][NEUTRAL] I need the date of service and the total amount billed.
[CUSTOMER][NEUTRAL] OK, so it's [PII]. The total amount we sent for, uh, first we sent Blue Cross Blue Shield is $350 and the patient is responsible for $15 co-payment.
[AGENT][NEUTRAL] OK, so it's $350 total. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, yes, we did receive that claim and to answer your other question, it does not cover for office visits or any services or procedures inside the doctor's office.
[CUSTOMER][NEUTRAL] OK, it's not covered. And you know if the member uh know this information?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] If you know if the member uh knows this information because they say they, this insurance will cover co-payment, that's why they give it to us.
[AGENT][NEUTRAL] I'm not certain if the member knows that information or not, but the policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK, that's fine. Let me see if you can help me with another member. I will appreciate it. Can I get the reference number for this one?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] We do not use reference numbers. You can use my name [PII] last initial [PII], and today's date. Now the next number would be under the same policy number or a different policy number please Lisa?
[CUSTOMER][NEUTRAL] Uh, different policy.
[AGENT][POSITIVE] OK, one moment, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And of course you can check claim status by visiting our secure portal at [PII] as well. Um, if you needed a copy of the EOB, you can obtain it from that website, but what is that second policy number, please? I'm ready.
[CUSTOMER][NEUTRAL] Yes, 02045251 and [PII]
[AGENT][POSITIVE] OK, thank you very much one moment.
[AGENT][NEUTRAL] And let me just repeat that policy number just to make sure I have that correct. I have that as 02045251 ML8.
[CUSTOMER][POSITIVE] Mhm. Yes, correct.
[AGENT][NEUTRAL] Thank you, verify the patient's name and date of birth please.
[CUSTOMER][NEUTRAL] Is uh [PII], [PII].
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] Let me just make sure I have that correct policy number. I have that as 02045251 ML8.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I do not show that number under this policy number.
[AGENT][NEUTRAL] Do you don't know who the policy holder is?
[CUSTOMER][NEUTRAL] [PII] as a [PII].
[CUSTOMER][NEUTRAL] I have the group number. I don't know if you need it.
[AGENT][NEUTRAL] 23. OK one moment.
[AGENT][NEUTRAL] What is the group number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, the, the subscriber or you need the patient's name? Because it's a long last name [PII].
[AGENT][NEUTRAL] I'm sorry, I thought you mentioned you have the group number.
[CUSTOMER][NEUTRAL] Oh, the group number, sorry. 242.
[CUSTOMER][NEUTRAL] 45.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, I was able to locate the member under a different policy number. Um, give me one second, but that date of service.
[AGENT][NEUTRAL] What is that date of service and build them out please?
[CUSTOMER][NEUTRAL] Uh, [PII], and the total amount is $652 and the primary insurance patient is responsible for $40 co-payment.
[AGENT][NEUTRAL] [PII]. OK, I want on that policy number.
[AGENT][NEUTRAL] I'm still searching for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me provide you with the correct policy number. The correct policy number is 02500540ML.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] OK, so let me search for that date of service now one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you to get that the total charge amount was $652. I just wanna make sure that's correct. I don't.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I did not. OK, give me one second.
[AGENT][NEUTRAL] 22.
[AGENT][POSITIVE] OK, thank you so much for your patience.
[AGENT][NEGATIVE] I do show that we received the claim and it shows that it denied um this particular policy also does not cover office visits.
[CUSTOMER][POSITIVE] OK. Thank you so much for your help. I appreciate it. Have a great day, [PII].
[AGENT][POSITIVE] You're very welcome, [PII], and thank you so much for calling AP. Take care. Have a great weekend. Thank you.
[CUSTOMER][NEUTRAL] Bye-bye. You too. Bye-bye.
[AGENT][NEUTRAL] Bye.