AccountId: 011433970860
ContactId: e50eb26d-4c69-4f64-9b8b-74d86a243001
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335029 ms
Total Talk Time (AGENT): 158281 ms
Total Talk Time (CUSTOMER): 115578 ms
Interruptions: 7
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/e50eb26d-4c69-4f64-9b8b-74d86a243001_20250403T14:07_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 am calling from a doctor's office to verify a patient's eligibility.
[AGENT][NEUTRAL] OK, you're needing eligibility only. You do not also need benefits. Is that correct?
[CUSTOMER][POSITIVE] Yes, I do need the benefits as well.
[AGENT][NEUTRAL] So you need eligibility and benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Um, this is [PII] at Saper Family Practice.
[AGENT][NEUTRAL] OK. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] One second, what's the callback number? Oh, this, uh, sorry, uh, uh, [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] OK, the policy number is 02610253.
[AGENT][NEUTRAL] OK, thank you, [PII], one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the information [PII] that I do provide 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] Um, [PII], date of birth is, uh, [PII].
[AGENT][NEUTRAL] OK, is this [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] How are you?
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] OK, so I do show she is the subscriber on the supplemental policy and the supplemental policy.
[CUSTOMER][POSITIVE] So we should bring it next time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So now on this policy, office visits are not covered. If she were to receive some type of treatment related to accident or sickness within the office, that is something that can be reviewed under her outpatient benefits and she has an outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, let me.
[AGENT][NEUTRAL] Well, bear with me just one second. I'm sorry, [PII].
[CUSTOMER][POSITIVE] You're good. You're good.
[AGENT][NEUTRAL] So she has an outpatient benefit maximum.
[AGENT][NEUTRAL] Her calendar year for covered outpatient services of $5000 with no deductible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if you all do file a claim with APL we will also have to have a copy of her primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] How are you?
[AGENT][NEUTRAL] And then once we have processed our claim here we do have a portal in which you should be able to check claim status and our portal website Erin is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so we file a complaint, uh, um, claim and stuff that y'all need a copy of what else.
[AGENT][NEUTRAL] The primary, along with the claim form, we will need a copy of our primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Um-hum.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's alright I got you. Alright, and what else do you need?
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Again, that would be the claim form and the primary EOB.
[CUSTOMER][NEUTRAL] Is that?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For our review.
[CUSTOMER][NEUTRAL] OK, what else? Is that everything?
[AGENT][NEUTRAL] That's it.
[CUSTOMER][POSITIVE] OK, alright, thank you.
[AGENT][NEUTRAL] Uh-huh, it is.
[CUSTOMER][NEUTRAL] And what's the reference number for this call?
[AGENT][POSITIVE] Well, you're certainly very welcome. My name that I gave you along with today's date.
[CUSTOMER][POSITIVE] And what's your name again? I'm so sorry.
[AGENT][NEUTRAL] And is there anything else, [PII] I can?
[CUSTOMER][NEUTRAL] Uh, no, ma'am, it was, I'm so sorry, what is your name again? [PII], OK.
[AGENT][NEUTRAL] I you [PII].
[CUSTOMER][POSITIVE] Alright thank you so much.
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, you're certainly very welcome. So again, if that's all I can help with, thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes ma'am, thank you as well bye bye.
[CUSTOMER][NEUTRAL] Bye.