AccountId: 011433970860
ContactId: df3f8ea7-c692-4ba6-9a40-990ae48c7826
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289730 ms
Total Talk Time (AGENT): 152315 ms
Total Talk Time (CUSTOMER): 71521 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/df3f8ea7-c692-4ba6-9a40-990ae48c7826_20250501T17:06_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. I'm calling from Doctor [PII]'s office. Uh, we have a mutual patient that I needed to verify benefits on.
[AGENT][NEUTRAL] OK, you're only needing benefits. You do not need eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, well, yeah, eligibility and benefits.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with both. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII] and I'm calling from the provider's office.
[AGENT][POSITIVE] Thank you and [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] What is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't have that in front of me. I have his date of birth and name.
[AGENT][NEUTRAL] OK, I can't search by date of birth. OK, so on the ID card you said you do or do not have this card?
[CUSTOMER][NEUTRAL] And I have his card.
[CUSTOMER][NEUTRAL] Yes, I have the ID card. I have the uh, I don't know if you need the payer ID or group number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, neither. There should also be another number on the front.
[CUSTOMER][NEUTRAL] Uh, oh, outpatient benefits cert number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 02504925 M as in Mary L as in Mary, the number 8.
[AGENT][NEUTRAL] OK, thank you. So give me a couple moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information, [PII], 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 please and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is a subscriber on this supplemental policy and it is active with an effective date of [PII]. And what type of benefit information do you need, [PII], inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Office copies.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit.
[AGENT][NEUTRAL] Well it's still loading. I'm sorry. The outpatient benefits per calendar year for covered outpatient services is $7900.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because this is a supplemental policy to the primary insurance when the claim is submitted to APL for review, we will also have to have a copy of this primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal, Rachel that you all should be able to check claim status in and the website for that is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And then for office visits, is his co-pay covered?
[AGENT][NEUTRAL] Again, I can't guarantee payment. I can only verify what the benefits are on this policy.
[CUSTOMER][NEUTRAL] Correct, but the, the patient's mentioning that you guys pay for his co-pays, so he didn't want us to charge him his co-pay. So that's why I need to verify if office copays are included.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Office, yes, ma'am. Office visits would fall under that outpatient benefit maximum. This particular supplemental policy does have benefits for office visits.
[CUSTOMER][NEUTRAL] OK, and how much of that 7900 has you net?
[AGENT][NEUTRAL] I can check that for you one moment.
[AGENT][NEUTRAL] As of now, he has you $60.
[CUSTOMER][NEUTRAL] OK, perfect. And is there a reference number for this call?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. And again, is there anything else, [PII], I can help you with today?
[CUSTOMER][POSITIVE] Mhm. That'll be all. Thank you.
[AGENT][POSITIVE] OK. Well, thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.