AccountId: 011433970860
ContactId: e163b6bc-857e-454a-a34f-5dd0f180eca9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204029 ms
Total Talk Time (AGENT): 112013 ms
Total Talk Time (CUSTOMER): 55347 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/e163b6bc-857e-454a-a34f-5dd0f180eca9_20250313T19:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to get benefits eligibility for a patient that's on here. She says she's stating that um you guys should cover her co-payment for today's visit for an office visit.
[AGENT][NEUTRAL] OK, so you're wanting to verify eligibility and benefits for an office visit, is that correct?
[CUSTOMER][NEUTRAL] Yes, for a specialist office visit.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Um, is that where it says, uh, group number, uh, coverage?
[AGENT][NEUTRAL] It would be dependent, depending, depending on the type of policy it is, [PII] is how it would be worded. It may, you may see an in-hospital or an outpatient number. You may see policy, OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, yeah, outpatient benefit certain number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's 02152631 ML8.
[AGENT][POSITIVE] OK, thank you very much. One moment, please.
[CUSTOMER][NEUTRAL] I'm
[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 and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so she is the subscriber on this supplemental policy?
[AGENT][POSITIVE] And the policy is active with an effective date.
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] And again you said this is for an office visit, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, a specialist office visit.
[AGENT][NEUTRAL] OK, so on this supplemental policy, office visits are not covered.
[AGENT][NEUTRAL] If she were to receive some type of treatment rendered in the office, then we can review the treatment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Under her outpatient benefits, but the office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect alrighty I would just need you said your name is [PII]?
[AGENT][NEUTRAL] Yes ma'am, and then you would use my name along with today's date as your call reference number.
[AGENT][NEUTRAL] And then [PII] for future reference if a claim is ever filed with APL on this type of policy, we would have to have a copy of the primary insurance explanation of benefits with the claim and then once the claim has been processed by us, we do have a portal that you should also be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK. And is there anything else I can help you with?
[CUSTOMER][POSITIVE] Alrighty thank you so much.
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] Oh, you're welcome. Yes, ma'am. Well, you're certainly welcome and thank you for calling APL. I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.