AccountId: 011433970860
ContactId: e15554a4-d2b3-49fe-96b2-1fbc0471476a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283920 ms
Total Talk Time (AGENT): 127186 ms
Total Talk Time (CUSTOMER): 102223 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/e15554a4-d2b3-49fe-96b2-1fbc0471476a_20250611T13:02_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I'm needing to uh verify eligibility and benefits to see exactly um what the customers or what the patient's responsibility is and where claims would go as this is showing to be his secondary.
[AGENT][NEUTRAL] OK, may I have your name please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] Thank you, [PII] and your callback number?
[CUSTOMER][NEUTRAL] Is [PII] and that's a direct line.
[AGENT][NEUTRAL] OK, thank you, [PII]. May I have the policy number please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, policy number is 1265691.
[AGENT][NEUTRAL] OK, let me just repeat that to you, please. I have that as 1265691.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, thank you so much. And may I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, I have [PII] [PII].
[AGENT][NEUTRAL] OK, thank you so much for the information. Excuse me, and you're calling to verify eligibility benefits and get a mailing address to send claims. OK, yes ma'am. Uh, this policy shows, yes ma'am, as of [PII], he is the policyholder. It shows active. And what benefit would you need please for the member I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, it's going to be for, uh, behavioral health, and I do have a CPT code if that helps.
[AGENT][NEUTRAL] Uh, with this policy there's no pre-certs or pre-authorizations because we're secondary. Let me just see here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is for an office setting, is that correct? Would it be a facility?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, office.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And my apologies, [PII], this member does not have a benefit to cover for an office visit fee.
[AGENT][NEGATIVE] So that would not be covered.
[CUSTOMER][NEUTRAL] OK, what about for facility?
[AGENT][NEUTRAL] For facility, um, please note verification of benefits provided does not guarantee payment. We will pay up to $4750 for the calendar year for outpatient facility.
[AGENT][NEUTRAL] There is a deductible, give me one second, and that deductible shows $250.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And where would those claims go?
[AGENT][NEUTRAL] Yes, ma'am. That'll be mailed to APL claims.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And if you could repeat that um [PII] just one more time just to make sure I have it correct.
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] OK perfect that's what I have and do you have the payer ID?
[AGENT][NEUTRAL] Yes, ma'am. It is 60801.
[CUSTOMER][NEUTRAL] Perfect. And then do you have the timely filing for those claims?
[AGENT][NEGATIVE] Uh, there's no timely filing with us with APL.
[CUSTOMER][NEUTRAL] OK, perfect, yes ma'am. And would this be something um that the patient would have to reach out as this is um a gap insurance policy or is this something that um they could do at the facility level?
[AGENT][NEUTRAL] Uh, the, excuse me, the excuse me, the facility or a provider can submit a claim and what we would need of course would be that, um, claim form or you be you beO4 along with the explanation of benefits to submit to us.
[CUSTOMER][NEUTRAL] OK perfect and what was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And the first letter of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Perfect and then do we have a reference number for the call or do I just use your name in today's date?
[AGENT][NEUTRAL] Just my name and today's date please [PII] thank you.
[CUSTOMER][POSITIVE] OK perfect yes ma'am thank you so much for all the help.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thank you for calling APL. Have a great day. Thank you.
[CUSTOMER][NEUTRAL] You too mhm.