AccountId: 011433970860
ContactId: f7db745e-a67c-435c-9494-4087b930a592
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300700 ms
Total Talk Time (AGENT): 165801 ms
Total Talk Time (CUSTOMER): 79780 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/f7db745e-a67c-435c-9494-4087b930a592_20250414T19:52_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from Doctor [PII]'s office. Um, we have a patient with, um, this insurance to see if her appointment for today will be covered by you guys.
[AGENT][NEUTRAL] OK, so are you needing eligibility and benefits, both or just eligibility? I'm not gonna be able to guarantee.
[AGENT][NEUTRAL] Anti-payment.
[CUSTOMER][NEUTRAL] OK, um, it's for her. She has a specialist visit with us today for breast evaluation, and we're trying to see if, um, her copay is covered by you guys. So I don't know if that falls on benefits and eligibility.
[AGENT][NEUTRAL] Yes, ma'am. Well, I can check eligibility and benefits for you. Um, I can help you with this, and who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, [PII], thank you. And what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 18848
[AGENT][NEUTRAL] OK, thank you. Give me a moment please, just to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And any information, [PII] 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] [PII]
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. So she is the subscriber on the supplemental policy, and this supplemental policy, [PII] is active with an effective date of [PII].
[AGENT][NEUTRAL] Now, on this policy,
[AGENT][NEUTRAL] It does not cover office visits.
[AGENT][NEUTRAL] However, if she does have some form of uh treatment or procedure done in the office, we could review that under her outpatient benefit maximum.
[AGENT][NEUTRAL] On the supplemental policy.
[AGENT][NEUTRAL] And on the supplemental policy, she does have an outpatient benefit maximum per calendar day of $300 for covered outpatient services with no deductibles.
[AGENT][NEUTRAL] But again, the office visit itself is not covered.
[CUSTOMER][NEUTRAL] OK, perfect. So, um, for specialist visits she does not, you guys don't cover, correct?
[AGENT][NEUTRAL] Not for the
[CUSTOMER][NEUTRAL] I'm sorry, you cut off. Repeat one more time. I'm sorry.
[AGENT][NEUTRAL] The visit itself. No, ma'am.
[AGENT][NEUTRAL] Correct. For the office visit, it would not be covered under this supplemental policy.
[CUSTOMER][NEUTRAL] OK, can I have a reference number?
[AGENT][NEUTRAL] Now, if, if you are in.
[AGENT][NEUTRAL] Mhm, yes, ma'am, but let me give you a couple of additional pieces of information, [PII]. Should you all end up filing, yes, ma'am.
[CUSTOMER][NEGATIVE] Oh yeah, go ahead, sorry, is that you're cutting in and out so I couldn't hear.
[AGENT][NEUTRAL] And it's the line, I'm sorry, and I
[AGENT][NEUTRAL] I can't do anything about it, unfortunately. I'm so sorry guys.
[CUSTOMER][NEUTRAL] No, no, no, it's OK.
[AGENT][NEUTRAL] Um, so if you all were to submit a claim to us for review, we will.
[AGENT][NEUTRAL] Also have to have a copy of her primary insurance company's explanation of benefits as well, since this is a supplemental policy and then once we have processed our claim here at APL we do have a portal in which you should be able to check.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] status for us and our portal we look at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, is there anything else that I could help you with this afternoon, [PII]?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK, well, thank you so much for calling APO this afternoon.
[CUSTOMER][NEUTRAL] Can I have a reference number please?
[AGENT][NEUTRAL] Yes, ma'am. You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK, what's your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], uh huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the first initial to my last [PII] and today's date. Mhm.
[CUSTOMER][NEUTRAL] And today's a [PII], uh huh.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Alrighty bye bye bye bye.