AccountId: 011433970860
ContactId: e69bec5f-8385-4d54-8653-29e5de57c5b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225429 ms
Total Talk Time (AGENT): 124097 ms
Total Talk Time (CUSTOMER): 47197 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/e69bec5f-8385-4d54-8653-29e5de57c5b9_20250227T18:58_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] Um, yes ma'am, I was calling um to get benefits for facility and professional on a CPT code.
[AGENT][NEUTRAL] OK, you're needing benefits and eligibility for a member?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 02049543.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, and any information that I do provide for you, [PII], will 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] Um [PII], date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the subscriber on the supplemental policy.
[AGENT][NEUTRAL] And the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And again, what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, outpatient ambulatory service center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max per calendar year per cover person of $4500 with no, with a $500 outpatient deductible per covered person.
[AGENT][NEUTRAL] And again, this is a supplemental policy to her primary insurance.
[AGENT][NEUTRAL] So when you all file a claim with APO you will also need to include a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and do you guys cover um everything that her primary doesn't cover?
[AGENT][NEUTRAL] No, ma'am, not necessarily. It would have to be a covered benefit under this policy, but we would have to receive the claim in order to review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This policy is designed to help with co-pays, deductibles, and co-insurance amounts of covered services. Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. All right, thank you so much.
[AGENT][NEUTRAL] OK. Well, you are certainly welcome. And then again, um, as I stated about sending the prime, make sure to send the primary insurance's explanation of benefits as well. And then once we have reviewed a claim, Pam, we do have a portal that you should be able to check claim status in and our portal website is secured.
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you so much I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that is all I can help you with, thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.