AccountId: 011433970860
ContactId: f2127c2b-229a-4dec-a0c9-396ab5cb30e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476679 ms
Total Talk Time (AGENT): 196793 ms
Total Talk Time (CUSTOMER): 96089 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/f2127c2b-229a-4dec-a0c9-396ab5cb30e9_20250326T14:24_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, my name is [PII]. I was calling to get eligibility and benefit information.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][POSITIVE] [PII], that's correct.
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It is D as in David 41203571.
[AGENT][NEUTRAL] OK, thank you, [PII], but that is not an APL number, that is a 90 degree benefit number.
[AGENT][NEUTRAL] Does the member also have a policy with APL?
[AGENT][NEUTRAL] There should be another number on their ID card.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean, I called 90 Degree and they said there is another plan that covers non-preventive services, but I don't see any other ID number.
[AGENT][NEUTRAL] OK, so do you have a member's full social so that I can look up their information?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you today would.
[AGENT][NEUTRAL] Be a verification of benefits and not a guarantee of pay. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I did locate a policy for her. She is a subscriber. The correct policy number that you should have, [PII] is 259-614-8.
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] This is a limited benefit plan, so what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, it's for a specialist office visit.
[AGENT][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit for an office visit a $75.
[AGENT][NEUTRAL] Dollars per visit.
[AGENT][NEUTRAL] That's, I'm sorry, that is $75 maximum number of visits of $5 per calendar year.
[CUSTOMER][NEUTRAL] OK, sorry, your phone was cutting out. You said it's $75 per visit up to 5 visits per year?
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK, and what network does the plan use?
[AGENT][NEUTRAL] This is a multi-plan network.
[AGENT][NEUTRAL] Plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And if you will, I'm sorry, go ahead. I don't mean to interrupt you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] No, that's OK. I was just gonna ask if I could get your claims mailing address.
[AGENT][NEUTRAL] OK, for this member's policy, claims would be sent to IMA.
[AGENT][NEUTRAL] And the [PII] box is [PII].
[AGENT][NEUTRAL] [PII], which is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the payer ID is 6455.
[AGENT][NEUTRAL] 6.
[CUSTOMER][NEUTRAL] Sorry, what was the last number? 6?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 645-56.
[AGENT][NEUTRAL] And also [PII], once the claim has been submitted and processed, we also have a portal here at APL that you should be able to check claim status in.
[AGENT][NEUTRAL] And our portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I like
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when billing for the claim, um, would this be a whole separate coverage than the 90 degree benefits because it looks like the mailing address is the same.
[AGENT][NEUTRAL] Yes, but if it's for an APO claim, then you would need to, you know, I mean, it is the same address. The type of plan they have is just, they have like a dual option for different benefits, but the claims then get routed through.
[AGENT][NEUTRAL] From that IMA address.
[AGENT][NEUTRAL] Properly, that's their clearing house.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then can I
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Are you able to see if the patients used any of those office visits so far this year?
[AGENT][NEUTRAL] I can check that for you. Just one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] As of now, no, ma'am.
[CUSTOMER][NEUTRAL] OK, and can I get a call?
[AGENT][NEGATIVE] There have not been any benefits.
[CUSTOMER][NEUTRAL] OK, sorry. um.
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] A call reference number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes, ma'am. You would use my name along with today's date.
[CUSTOMER][NEUTRAL] Did you say your name was [PII]?
[AGENT][NEUTRAL] I did. Mhm.
[CUSTOMER][POSITIVE] OK awesome thank you very much.
[AGENT][POSITIVE] Well, you are certainly very welcome. So is there anything else I can help you with this morning, [PII]?
[CUSTOMER][POSITIVE] No, that is it. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye