AccountId: 011433970860
ContactId: ea929acd-6293-42c6-adb7-dfdc509f965d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409410 ms
Total Talk Time (AGENT): 223556 ms
Total Talk Time (CUSTOMER): 101667 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ea929acd-6293-42c6-adb7-dfdc509f965d_20250108T16:31_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 [PII] calling for a provider I'm checking benefits please.
[AGENT][NEUTRAL] OK, you're needing to check on benefit information for members, is that correct? Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][POSITIVE] Yes, mhm, yes I am.
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Direct line [PII].
[AGENT][NEUTRAL] Thank you. One moment, please, [PII]. What is the member's policy number?
[CUSTOMER][NEUTRAL] I'm really not sure. I see two different ones. I see outpatient benefit certificate number. Is that what it would be?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, yes ma'am. Are you needing outpatient benefit information? Yes, ma'am. OK.
[CUSTOMER][NEUTRAL] Yes, office visit.
[CUSTOMER][NEUTRAL] 02046823ML8
[AGENT][NEUTRAL] So that was 02046823 was the first part of the number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [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] [PII] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Now when I filed, do I need that ML8 on the end of it or not?
[AGENT][POSITIVE] Yes, ma'am. You can, you can include that. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you hold on until I get this please?
[AGENT][POSITIVE] Yes, ma'am, I can.
[CUSTOMER][NEGATIVE] You know, I'm not even going to pick it up.
[AGENT][NEUTRAL] You can, that's fine, you can, that's.
[CUSTOMER][NEGATIVE] No, it's, I know who it is. It'll take forever.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. All right then.
[CUSTOMER][NEUTRAL] You have reached the.
[AGENT][NEUTRAL] And you said you were needing, OK. So first off, any information again that I provide will be a verification of benefits and not a guarantee of payment. And what was Mr. [PII] uh date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Please contact doctor.
[AGENT][NEUTRAL] OK. And you did say, I'm sorry, I got distracted myself. He is the patient?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am. OK, so he is also the subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And give me one moment to get his benefit information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this supplemental policy, office visits are not a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he was also in the hospital.
[CUSTOMER][NEUTRAL] And he went in through the ER.
[AGENT][NEUTRAL] As an inpatient?
[AGENT][NEUTRAL] OK. Was it in the ER or just an ER visit, or was he admitted inpatient?
[CUSTOMER][NEUTRAL] No, it was
[CUSTOMER][NEUTRAL] Inpatient, it rolled over the inpatient.
[AGENT][NEUTRAL] OK, so he does have
[AGENT][NEUTRAL] Under, well, he has emergency room benefits under his outpatient deductible. It'll be dependent upon, you know, we'll just have to receive the claim to review the out. I'm sorry, cause I thought you had said it was an office visit.
[CUSTOMER][NEUTRAL] Well, both. He's in today for an office visit.
[AGENT][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] But he, in December he was in the hospital inpatient came in through the ER.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so his outpatient benefit maximum for covered outpatient services, ma'am, is $6600 per covered person per calendar year.
[AGENT][NEUTRAL] With no outpatient deductible.
[AGENT][NEUTRAL] Actually, and on his emergency room, there is no deductible on that yet, but that's a per occurrence.
[AGENT][NEUTRAL] Then his inhospital benefits.
[AGENT][NEUTRAL] Give me one moment, that's still trying to pull in for me.
[AGENT][NEUTRAL] So he has an in-hospital benefit maximum also of $6600 per covered person per calendar year with no in-hospital deductible.
[CUSTOMER][MIXED] OK, but that's the max you pay.
[AGENT][NEUTRAL] Mhm. For covered services, yes, ma'am. And we will have
[CUSTOMER][NEUTRAL] OK, and was anything used last year?
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] No, ma'am. There was not.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Address for claims.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Yeah timely filing.
[AGENT][NEGATIVE] No timely filing?
[CUSTOMER][NEUTRAL] None
[AGENT][NEUTRAL] None
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we do have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] All right, understandable.
[AGENT][NEUTRAL] Along with the itemized bill, mhm, the itemized bill and claim. Mhm.
[CUSTOMER][POSITIVE] All right, I thank you very much bye.
[AGENT][NEUTRAL] For the claim.
[AGENT][NEUTRAL] Well you are so and one last thing, [PII], once the claim has been processed through APL you may check claim status by going to our portal at [PII] and also you would have access to the explanation of benefits there as well.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Oh very good, thank you again have a good one.
[AGENT][POSITIVE] OK, well, you're welcome, yes ma'am and thank you again for calling APO.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.