AccountId: 011433970860
ContactId: f8f84b5b-b598-466e-8b52-722d8a611384
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 348140 ms
Total Talk Time (AGENT): 126281 ms
Total Talk Time (CUSTOMER): 115769 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/f8f84b5b-b598-466e-8b52-722d8a611384_20250218T20:05_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I need to verify benefits for our patient.
[AGENT][NEUTRAL] OK. I can verify benefits for you. And your name is?
[CUSTOMER][NEUTRAL] [PII], that's [PII]
[AGENT][NEUTRAL] OK. And what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number I have is 02548904.
[AGENT][NEUTRAL] OK, thank you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] That's my name, yes.
[AGENT][NEUTRAL] OK, and what is that policy number, please? I mean, what is the callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you ma'am, give me one moment.
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII], uh date of birth, [PII].
[AGENT][NEUTRAL] And I apologize. Give me that policy number one more time. You said 254.
[CUSTOMER][NEUTRAL] And 02548904.
[AGENT][NEUTRAL] OK, and this is for [PII], correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active on the policy and
[AGENT][NEUTRAL] Is this for cancer?
[CUSTOMER][NEUTRAL] Um, so she has a cancer diagnosis, yes. She's coming in for, uh, interventional radiology procedure.
[AGENT][NEUTRAL] OK, one
[CUSTOMER][NEUTRAL] It's a port placement.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this is for surgery.
[CUSTOMER][NEUTRAL] It's um it's a port placement, interventional radiology.
[AGENT][NEUTRAL] OK. It shows she has a radiation benefit under the plan.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But we do need the primary EOB.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK, let me ask you this, this particular plan, does it work like you guys reimburse the patient directly?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, most times it's paid to the insured. Um, let me double check with the examiner and see if we do pay providers. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][NEUTRAL] I am fine and [PII] on this Tuesday. I wish it was Friday, but it's all good, uh.
[CUSTOMER][NEUTRAL] I know, right?
[AGENT][NEUTRAL] But I have a quick question for you. For these cancer policies, can we pay the provider?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, because I have a provider they're wanting benefits for, I guess radiation port and
[AGENT][NEUTRAL] Wouldn't that be considered surgery, putting in a port?
[CUSTOMER][NEUTRAL] Yes, the thing is with the providers, um, they will submit just like they would like a medin, so we'll need the claim and uh EOB if it's a benefit, um, outside of like, well, no, any of the benefits really, if they have a out of pocket specifically for that service, we'll pay that amount and anything left over we'll pay to the insured, but yeah, we, we, we can pay the providers.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I wasn't sure. I thought we did on um the cancel policies, but I just want to double check.
[CUSTOMER][POSITIVE] Yeah, we sure do.
[AGENT][POSITIVE] Well, all right. Thank you, ma'am. Have a great one.
[CUSTOMER][POSITIVE] No problem. Anytime. You as well. Bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK, Ms. [PII], thank you so much for holding, but I did speak with an examiner and we can pay the provider. Uh, so what we would need is a copy of the bill and the primary EOB.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So primary BOB. OK, all right, all right, all right, so that's all I needed. Can I get a call reference number?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh, we don't give reference numbers, but if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] What is your name?
[AGENT][NEUTRAL] It's [PII], last initial [PII].
[CUSTOMER][POSITIVE] Perfect alrighty thank you so much I appreciate it.
[AGENT][POSITIVE] Uh, yes, ma'am. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye bye.