AccountId: 011433970860
ContactId: f764ad02-7dd0-4168-bd35-a51a5a6c1405
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 640090 ms
Total Talk Time (AGENT): 226403 ms
Total Talk Time (CUSTOMER): 281087 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/f764ad02-7dd0-4168-bd35-a51a5a6c1405_20250414T14:54_UTC.wav
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[CUSTOMER][NEUTRAL] Just right now maybe my number.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider office. How are you doing today, K?
[AGENT][POSITIVE] I'm doing well, [PII] how are you?
[CUSTOMER][POSITIVE] Yeah, I'm good. I'm good, thanks for asking. Could you please spell your first name?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][POSITIVE] That's perfect. And initial last?
[AGENT][NEUTRAL] A
[CUSTOMER][POSITIVE] That's perfect.
[CUSTOMER][NEUTRAL] Yeah, would you please, uh,
[CUSTOMER][POSITIVE] Help me to get the eligibility and the benefit status for a member.
[AGENT][POSITIVE] Sure, I can check eligibility and benefits for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, you can call me directly on [PII].
[AGENT][NEUTRAL] Thank you. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Just wait a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually, I just have the member name and the group number on the card of APL.
[AGENT][NEUTRAL] OK. Oh.
[CUSTOMER][NEUTRAL] I'm able to find out the, yeah.
[AGENT][NEUTRAL] If you're looking at the card, do you see somewhere that says uh in hospital or outpatient certification number?
[CUSTOMER][NEUTRAL] Uh, sure. OK. Outpatient benefit send a contact number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure. And uh I'm just facing some difficulty to read out because
[CUSTOMER][NEGATIVE] And the client send me the card and the image is very dull to understand. Can you get this information with the name and date of birth?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you happen to have their social by chance?
[CUSTOMER][NEUTRAL] Uh, no, I have her primary insurance information. If you want, I can provide it.
[AGENT][NEUTRAL] Uh no, I wouldn't be able to use the primary, um, OK, but you said you were able to read the group number?
[CUSTOMER][POSITIVE] Yes, that's perfect.
[AGENT][NEUTRAL] OK, we can try that way.
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEUTRAL] Sure. The group number is 18748.
[AGENT][NEUTRAL] OK and then uh what was the member's first and last name please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Members first and last is
[CUSTOMER][NEUTRAL] Member's first name is [PII], it's [PII] And [PII] is the last name is [PII]
[AGENT][NEUTRAL] OK, BAI, OK, one moment, let me try to find him.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, is he the primary? Do you know if he's the primary or not?
[CUSTOMER][NEUTRAL] Yes, I know the primary's information. They provide me the scanned his information.
[AGENT][NEUTRAL] On the account?
[AGENT][NEUTRAL] I'm, I'm sorry, I mean, um, I mean the uh the subscriber.
[CUSTOMER][NEUTRAL] Yes, subscriber's name is [PII].
[AGENT][NEUTRAL] OK, OK, and then did you have [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Sorry, what did you say?
[AGENT][NEUTRAL] Uh, [PII]'s date of birth, please.
[CUSTOMER][NEUTRAL] Yes, yes. [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Perfect. OK, so I did find this policy and it is currently active. Um, whenever you're ready I can give you that policy number.
[CUSTOMER][POSITIVE] Uh-huh. Sure, that's perfect. Just wait a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, what's the policy number?
[AGENT][NEUTRAL] Yes, that is 01261895.
[CUSTOMER][NEUTRAL] Sorry. Yes, sure home is 0126.
[AGENT][NEUTRAL] 1895.
[CUSTOMER][NEGATIVE] 1895. Actually, there is a distortion in the voice. There's the reason I'm unable to hear you properly.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] And the details which I've uh got from your side is 01261895. Is this perfect?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] It's 01261895. That's perfect. Sure. And what's the provider status? OK. When the plan is effective, what's the effective dates of this, ma'am?
[AGENT][POSITIVE] Yes, that is correct, yes.
[AGENT][NEUTRAL] So yes, it is.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Right, effective date was [PII].
[CUSTOMER][NEGATIVE] To steal.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Sure. And currently the plan is active and working as a scary insurance for this member.
[AGENT][NEUTRAL] Correct, uh, this is their secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's perfect. Is this plan covers the copay and deductibles of the members from the mental health providers?
[AGENT][NEUTRAL] Yes, uh, it goes towards co-pay, deductible and co-insurance, um, so was this for, um, did you want inpatient and outpatient benefits or just outpatient?
[CUSTOMER][NEUTRAL] Just outpatient provider offices.
[AGENT][NEUTRAL] OK, sure, and then of course I will let you know verification of coverage is not a guarantee of payment for claims, so the outpatient benefit is $1000 max per calendar year and if you'll give me one moment I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] OK, so none of that benefit has been used so far this year.
[CUSTOMER][NEUTRAL] OK. You said that it's 1000 out of pocket for this member.
[AGENT][NEUTRAL] That that's um the benefit amount that's the outpatient benefit amount that we would pay up to, yes, up to $1000 per calendar year.
[CUSTOMER][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] Outpatient, sure.
[CUSTOMER][NEUTRAL] Benefits.
[CUSTOMER][NEUTRAL] For member.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. What's the amount you said it's 1000 only.
[AGENT][NEUTRAL] Yes, $1000 per calendar year for outpatient benefits.
[CUSTOMER][NEUTRAL] And 0 have been met for this year.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's perfect. That's perfect. And could you please also um provide me the their address to submit the scanty claims?
[AGENT][NEUTRAL] Oh yeah, so that's gonna be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] That's the address, that's the mailing address, [PII]. Uh, just wait a moment. I just verify this address.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Sorry?
[CUSTOMER][POSITIVE] That's perfect. I'm just verifying this address is [PII]. That's perfect.
[AGENT][NEUTRAL] Of course I've also got a uh I've got a fax number and a payer ID as well if you'd like [PII].
[CUSTOMER][POSITIVE] That's perfect. That's the information I I want from your side.
[AGENT][NEUTRAL] OK, yes, so the fax number is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] That's perfect. And the payer ID?
[AGENT][NEUTRAL] Yes, that is 60.
[CUSTOMER][NEUTRAL] For electronic claims?
[AGENT][NEUTRAL] Uh-huh 60801.
[CUSTOMER][NEUTRAL] 801. Sure, that's perfect. Can I have the information which I got from your side. Could you please verify if I provide you the whole information which is documented in front of me? Sure. Uh, you said that the patient plan is effective from [PII] to still?
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] And the outpatient benefits for these members for this year of [PII] is 1000 out of which members have met zero. And the mailing address to submit the scary claims towards you is [PII], [PII] City, [PII], and the ZIP code is [PII]. Is this perfect?
[AGENT][POSITIVE] That is correct, yes sir.
[CUSTOMER][NEUTRAL] Sure. OK. And the fax number you provided me is [PII] uh sorry, the last four are [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] That's perfect. And the payer ID for the electronic submissions of claims is 60801. Is this perfect?
[AGENT][POSITIVE] Yes sir, that is correct.
[CUSTOMER][NEUTRAL] Sure. And what about the timely filing limits?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][POSITIVE] That's perfect for any of the provider, either provider is in network or out of network.
[AGENT][NEUTRAL] This plan does not participate in a network as it is uh heavily dependent on major medical as long as their major medical is willing to pay, this policy can.
[CUSTOMER][POSITIVE] That's perfect. So it depends on the primary policy.
[AGENT][POSITIVE] Uh yes, absolutely.
[CUSTOMER][POSITIVE] Yes, perfect.
[CUSTOMER][POSITIVE] Sure. That's perfect information which I want from your side. So [PII], what's the reference of this information?
[AGENT][NEUTRAL] That would just be my first name, last initial, and today's date. And was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][POSITIVE] No, thank you very much. Take care. Have a wonderful day. Nice talking with you. Bye-bye.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. You too. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.