AccountId: 011433970860
ContactId: f189a5b5-7ba4-403e-b59d-b996b069e9c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257399 ms
Total Talk Time (AGENT): 138519 ms
Total Talk Time (CUSTOMER): 76205 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/f189a5b5-7ba4-403e-b59d-b996b069e9c0_20250214T16:15_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, good morning, [PII]. Uh, my name is [PII]. I'm calling from Pembroke Pink Imaging in reference to outpatient benefits.
[AGENT][POSITIVE] OK, and I'm so sorry. Did you say [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And you're needing to verify benefits on a member? Is that correct?
[CUSTOMER][NEUTRAL] Yes. Yes, ma'am, ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that and [PII]. What is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It's 02312677.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And that 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 and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. You want me to spell it? It's, it's a weird name, last name.
[AGENT][NEUTRAL] Uh, you can, yes, ma'am.
[CUSTOMER][NEUTRAL] It's gonna be [PII]
[CUSTOMER][NEUTRAL] My first name, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what is the, her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So she is a subscriber on this supplemental policy, Alda?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy is active, effective [PII].
[AGENT][NEUTRAL] And because this is a supplemental policy to her primary insurance, there is not any network affiliated with this policy. It would follow her primary.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much is her ma?
[CUSTOMER][NEUTRAL] Are they here?
[AGENT][NEUTRAL] OK, are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient, outpatient, yes, OK.
[AGENT][NEUTRAL] OK, just, OK, which one, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Oh, OK, I'm sorry, I misheard you. OK, so she has an outpatient benefit max per calendar year for covered outpatient services of $4000.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now when a claim is submitted to APL for review ADA, we will also need for you to send a copy of a primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And then once we have processed our claim.
[AGENT][NEUTRAL] We do also have a portals that our claim status can be checked in and you should be able to access our EOB by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and [PII], um, um, how much has she, she used for her month?
[AGENT][NEUTRAL] One moment and you are referring to this calendar year?
[CUSTOMER][NEUTRAL] Yes, so this calendar.
[AGENT][NEUTRAL] OK. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] As of now, she has not used any of her benefits for this calendar year.
[CUSTOMER][POSITIVE] I'm very good, thank you. Can I have a reference number, [PII]?
[AGENT][POSITIVE] Yes ma'am you would use my name along with today's date.
[CUSTOMER][POSITIVE] With today's date. OK, [PII], everything's good. Thank you so much for your help.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's
[AGENT][POSITIVE] Well, you are certainly very welcome, [PII]. So that's all I can help you with. Thank you again for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.