AccountId: 011433970860
ContactId: eec21d0d-b96e-4dc2-b7e2-596061dbacba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332260 ms
Total Talk Time (AGENT): 154617 ms
Total Talk Time (CUSTOMER): 62781 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/eec21d0d-b96e-4dc2-b7e2-596061dbacba_20250304T13:24_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]. Good morning. Uh, my name is [PII]. I'm calling from a provider's office checking on, um, eligibility and benefits, right remember?
[AGENT][NEUTRAL] OK, did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], and you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, ma'am, I can help you with those things and [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's gonna be 0246.
[CUSTOMER][NEUTRAL] 5840 M. for Mary L. for Larry, number 8.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today 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] Yes. [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so first off, I need to give you a different policy number for them, [PII]. The policy number you gave me was never really active. It had an effective date and a term date of the same day, so the correct policy number should be 01659812. This policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For office, so I don't know if uh um office copay is covered.
[AGENT][NEUTRAL] For an office visit.
[AGENT][NEUTRAL] Is that correct for an office visit? OK, one moment please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and is this for primary care or specialist?
[AGENT][NEUTRAL] I'm sorry, [PII]. OK, so on this benefit plan, the, um, on the supplemental policy for a specialist office visit, the benefit is max is up to $50 per visit and a maximum of 4 visits per calendar year per covered person.
[CUSTOMER][NEUTRAL] A specialist.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that? I was getting something. OK.
[AGENT][NEUTRAL] Uh-huh, sure. Yes, so for a specialist office visit, the benefit is up to $50 per visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With a maximum of 4 visits per calendar year per cover person.
[CUSTOMER][NEUTRAL] So it's $50 right? $50.
[AGENT][NEUTRAL] And because
[AGENT][NEUTRAL] 50. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And because this is a supplemental policy, we will also have to have a copy of his primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] OK.
[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 for us, [PII] by going to [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Perfect. All right. Uh, can I have a reference number for our call or your name?
[AGENT][POSITIVE] Yes, ma'am, you would use, uh-huh, you're gonna use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, perfect. And what was your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. OK, perfect. Thank you very much, [PII].
[AGENT][POSITIVE] You are certainly very welcome. And is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No, that was all. Thank you.
[AGENT][POSITIVE] OK, well, you're certainly welcome and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mm