AccountId: 011433970860
ContactId: de513156-1792-42b8-b99b-ca77c44e8a0a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265100 ms
Total Talk Time (AGENT): 138912 ms
Total Talk Time (CUSTOMER): 77245 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/de513156-1792-42b8-b99b-ca77c44e8a0a_20250227T13:58_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, I'm calling to check for patient eligibility today.
[AGENT][NEUTRAL] OK, you're only needing eligibility. You do not need benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes, and I just have a question where to send like the claim payer ID and everything.
[AGENT][POSITIVE] Yes, I can help you with those things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII], and can I get yours as well?
[AGENT][NEUTRAL] The first [PII] my last name is also [PII].
[CUSTOMER][POSITIVE] Got it thank you.
[AGENT][NEUTRAL] You're welcome. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII], it's a direct line.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] ID number is 01887294 M for Mike L for Lima 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And now then 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 and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's for [PII], date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And I'm sorry, just to make sure your first name is [PII], right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] Got it, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I do show that he is the spouse of a subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And if you all will be filing a.
[CUSTOMER][POSITIVE] Thank you and no termination.
[AGENT][NEUTRAL] That is correct. And if you all will be filing a claim on this policy, we must also receive a copy of his primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed the claim, we do have a portal in which you should be able to check claim status by going to [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII]. Yes, you're welcome. And you said you needed claims mailing address?
[CUSTOMER][POSITIVE] [PII], got it, thank you.
[CUSTOMER][NEUTRAL] Yes, and then the payer ID as well.
[AGENT][NEUTRAL] OK. The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the payer ID is 60801.
[CUSTOMER][NEUTRAL] Thank you, is there also like a fax number where we can send the claims to?
[AGENT][NEUTRAL] Yes, [PII] attention claims.
[CUSTOMER][NEUTRAL] Got it thank you and what's your timely filing limit for sending the claim as secondary?
[AGENT][NEGATIVE] There is no timely filing.
[AGENT][NEUTRAL] There is a timely filing limit.
[CUSTOMER][NEUTRAL] Got it no timely filing limit. Got it. And just to make sure you mentioned, um, um, the patient has a supplemental, uh, secondary plan which has medical coverage, right?
[AGENT][POSITIVE] That is correct. Yes, sir.
[AGENT][NEUTRAL] This is the
[AGENT][NEUTRAL] This is the supplemental plan. We are not a major medical insurance. We are not the primary. We are the supplement, which is why we have to have a copy of the primary insurance company's explanation of benefits in order to review a claim.
[CUSTOMER][NEUTRAL] Got it thank you and I think that's all of the information I need from the plan uh [PII], can I get a reference number for our call today?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Got it thank you so much for your help and you have a wonderful day bye now.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I hope you do too,