AccountId: 011433970860
ContactId: e5360228-2451-47eb-97a1-75659cc07991
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265470 ms
Total Talk Time (AGENT): 121990 ms
Total Talk Time (CUSTOMER): 58458 ms
Interruptions: 2
Overall Sentiment: AGENT=2.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/e5360228-2451-47eb-97a1-75659cc07991_20250411T13:24_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from provider's office to verify a patient's on benefits and eligibility.
[AGENT][NEUTRAL] OK, you're needing to verify eligibility and benefits for members, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and who am I speaking with please?
[CUSTOMER][NEUTRAL] My name is [PII]. My last name initial is [PII].
[AGENT][POSITIVE] OK, thank you. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] 01842240
[AGENT][NEUTRAL] OK [PII], thank you. Give me a moment to get the member's information pulled up please.
[AGENT][NEUTRAL] And any information that is provided 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] [PII] with the date of birth of [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so I do show she is the subscriber on the supplemental policy, and this supplemental policy is active with an effective date of [PII]. And what type of benefit information, [PII], do you need inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] It would be for an office visit?
[AGENT][NEUTRAL] OK, so one moment.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK and the name
[CUSTOMER][NEUTRAL] I'll let them know you
[AGENT][NEUTRAL] OK, so on this supplemental policy for an office visit, the benefit would be $25 per visit and a maximum of 4 visits per cover person per calendar year.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, has she used any of this calendar year?
[AGENT][NEUTRAL] I can check that for you. One moment.
[AGENT][NEUTRAL] Uh, no, ma'am, as of now she has not. Now because this is a supplement to her primary insurance course, so when the claim is submitted to APL, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal that you should be able to check claim status in and that website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK, alrighty, perfect. OK, and then while I have you on the phone, um, the patient will be returning in a few weeks to get a possible, um, a sty drained, um, would that office visit apply to that? Is there a separate diagnostic charge or not diagnostic is like a separate office surgery charge?
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Let me see if she has benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That would all fall under that same benefit.
[CUSTOMER][NEUTRAL] Under the 25, OK.
[AGENT][POSITIVE] Yes, ma'am. That is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Uh, let's see. Yes, that is correct.
[CUSTOMER][POSITIVE] Alrighty perfect OK
[CUSTOMER][NEUTRAL] OK perfect then that is all that I needed. Is there a reference number for this call?
[AGENT][NEUTRAL] OK. Uh, you would use my name along with today's date?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And if that's all I can help you with, thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Yes ma'am. You're welcome. Bye bye.