AccountId: 011433970860
ContactId: e98841d1-5928-4fe3-8ee4-8ef2b41c4f9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337260 ms
Total Talk Time (AGENT): 152740 ms
Total Talk Time (CUSTOMER): 83175 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/e98841d1-5928-4fe3-8ee4-8ef2b41c4f9a_20250225T18:06_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 [PII], my name is [PII] and I'm with Doctor [PII], and we're seeing a patient that I need to know if we're in network.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] OK, [PII], so you're trying to find out about whether your provider is in network or not?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am. Well, I can help you with that and [PII], well, I can partially help you with that. Once I can see the type of plan the patient has, uh, what is your callback number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, [PII]?
[CUSTOMER][NEUTRAL] Is 02452016.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] OK, and any information 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 their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so you do not need eligibility. This is the only network that you're needing information on?
[CUSTOMER][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] Yes, I'm needing to know for in network before I schedule him an appointment.
[AGENT][NEUTRAL] OK, so on this limited benefit plan that he has with APL, uh, he is a subscriber, but this is not a network plan, so they may choose any provider.
[CUSTOMER][NEGATIVE] So with that being said they have no network.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So do you, you, we submit the billing and you tell us what the allowable charge is and the our company decides whether to balance bill him above that.
[AGENT][NEUTRAL] Yes, because we do not determine, we do not determine patient responsibility. This is not a major medical plan. This is a limited benefit plan.
[CUSTOMER][NEUTRAL] Is that what you're saying?
[CUSTOMER][NEUTRAL] And what does that mean by limited?
[AGENT][NEUTRAL] It pays specific dollar amounts for specific services for a specific number of.
[CUSTOMER][NEUTRAL] Is a screening colonoscopy on one of those.
[AGENT][NEUTRAL] OK, any information provided on benefits would be a verification of benefits and not a guarantee of payment. Give me a moment to get his benefit information pulled up please.
[AGENT][NEUTRAL] I'm sorry, it's just taking a moment to load everything.
[AGENT][NEUTRAL] And is this going to be done at an outpatient facility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so on here.
[AGENT][NEUTRAL] For accident and sickness surgery benefits, if it falls under a surgery benefit, it would, the benefit is $1500 per day, maximum of 2 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] So does this pay directly to [PII] instead of the facility? It sounds like a perde policy.
[AGENT][NEUTRAL] It would, it would pay to whomever files the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's what I needed to know. I appreciate the help, [PII].
[AGENT][NEUTRAL] OK, yes ma'am, well, you're certainly welcome and if you all do file a claim with [PII], once the claim has been processed, we do have a portal that you should be able to access um the status as well as the explanation of benefits.
[AGENT][NEUTRAL] And our website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK, and where do you submit the claims to physical address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, I appreciate the help. Thank you, [PII].
[AGENT][POSITIVE] Oh, you are so, yes, ma'am, you're very welcome. So if that's all I can help you with, thank you again for calling APL and I hope that you have a very nice afternoon.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.