AccountId: 011433970860
ContactId: eca14f08-0420-4838-9525-fd1fba709625
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370399 ms
Total Talk Time (AGENT): 182374 ms
Total Talk Time (CUSTOMER): 70988 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/eca14f08-0420-4838-9525-fd1fba709625_20250204T21:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi [PII], this is [PII], and I'm calling with Dustin Deemer's uh office to verify eligibility and benefits.
[AGENT][NEUTRAL] OK. Uh, you're needing eligibility and benefits, [PII], is that correct?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][POSITIVE] Yes, I can help you with those things. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02451474
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] It's so
[AGENT][NEUTRAL] OK, [PII] and any information that I do provide for you 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][NEUTRAL] OK, thank you. Now, are you calling for a future date to start what is this for future service dates or?
[CUSTOMER][NEUTRAL] For, uh, it's gonna be for [PII].
[AGENT][NEUTRAL] OK, so the policy number you gave me is an old policy that termed 101 of 2024.
[AGENT][NEUTRAL] There is another policy that is active, so let me get that information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I'll provide you the correct policy number that you should have now.
[AGENT][NEUTRAL] So the currently active policy is 024.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Wait just a minute, I'm sorry.
[AGENT][NEGATIVE] Oh, I was about to give you the wrong one. Hold on one second, [PII]. I'm sorry. I'm about to give you the same one you just gave me and I'm like, no, that's not correct.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, that's not right. OK, so the current active policy is 02551017.
[AGENT][NEUTRAL] And this policy has an effective date of [PII]. Your patient is the subscriber on the supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] Uh, office is a co-pay deductible.
[AGENT][NEUTRAL] OK, so this policy helps with his deductibles, copays, and co-insurance, um, of coverage services. We are a supplemental policy to his primary insurance. So let me see if office visits are covered. So just one moment under this plan.
[CUSTOMER][NEUTRAL] I'm sorry, what did you say?
[AGENT][NEUTRAL] We're not a primary insurance. This is his supplemental insurance. We're not a major medical carrier.
[CUSTOMER][NEUTRAL] To supplemental policy.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] This policy helps with co-pays, deductibles and co-insurance amounts of coverage services.
[CUSTOMER][NEUTRAL] OK, does it cover?
[CUSTOMER][NEUTRAL] OK, mhm.
[AGENT][NEUTRAL] Um, just a moment.
[CUSTOMER][NEUTRAL] OK, so I'll just I'll call the patient and see if they got can give me their primary information for insurance.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. No, so they did not give you their primary healthcare insurance information?
[CUSTOMER][NEUTRAL] No, they just gave me this is the only one we have on file for him.
[AGENT][NEUTRAL] Oh, OK. OK. Yes, ma'am. We're not, we're not a major medical carrier.
[AGENT][NEUTRAL] Uh, let's see. Just give me just a moment. I'm seeing if office visits are covered under this supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 156.
[AGENT][POSITIVE] Thank you for calling in.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And [PII], will there be a reference number for the call?
[AGENT][NEGATIVE] You're gonna use my name along with today's date and offices are not covered under this policy.
[AGENT][NEUTRAL] And when you all do file a claim, if you all do file a claim with us, [PII] on this policy, we will have to have a copy of his primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] As well
[AGENT][NEUTRAL] For review
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we do have a portal that you can check claim status for our claims in by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, and [PII], I don't have the specific information.
[AGENT][NEUTRAL] We show his major medical as Aetna, but that's all of the information that I have.
[CUSTOMER][NEUTRAL] You didn't find you you didn't find up yeah.
[CUSTOMER][NEUTRAL] OK, that's fine thank you.
[AGENT][POSITIVE] Alright, well, you're certainly welcome. So is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] All right, well thank you so much then for calling APL and I hope you have a nice evening.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye bye.