AccountId: 011433970860
ContactId: faffb315-c1ca-4982-8b4e-3bfeda341aac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273079 ms
Total Talk Time (AGENT): 164892 ms
Total Talk Time (CUSTOMER): 59204 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/faffb315-c1ca-4982-8b4e-3bfeda341aac_20250102T15:04_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] Um, hi [PII]. I'm needing to verify if patient has um eligible active coverage with you guys.
[AGENT][NEUTRAL] OK, so you're just needing to verify if the policy is active or not. You don't necessarily need benefits. Is that correct?
[CUSTOMER][NEUTRAL] Uh, well, yes, I will need benefits patient, um, have you guys listed as a secondary plan.
[AGENT][NEUTRAL] OK. So yes, I can help you with both of those things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK [PII] and what is a good call back number for you please in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] 0247
[CUSTOMER][NEUTRAL] 222 9.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And tells you any information that I did provide for you today will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Is it [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Do you have the last 4 for social by chance?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the spouse on this policy and it is active. The supplemental policy became effective for [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need on her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, office for imaging.
[AGENT][NEUTRAL] Done in a doctor's office, not in a
[CUSTOMER][NEUTRAL] Doctor's office, yes ma'am.
[AGENT][NEUTRAL] OK, so on this supplemental policy office visits.
[AGENT][NEGATIVE] And treatment done in the office setting are not covered under this plan.
[CUSTOMER][NEUTRAL] OK, so what, only if she's an inpatient at a hospital or?
[AGENT][NEUTRAL] Or if the diagnostic testing were to be done at a hospital or freestanding facility.
[CUSTOMER][NEUTRAL] OK, we are a free standing facility.
[AGENT][NEUTRAL] OK, so what we would need to do is to receive the claim. I'll give you the outpatient benefit maximum on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the outpatient benefit max is $5000 per covered person per calendar year.
[AGENT][NEUTRAL] For covered outpatient, I'm so sorry. Let me try that again. I gave you the wrong number. The outpatient benefit maximum, Taji is 4500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Per cover person per calendar year for covered outpatient services.
[AGENT][NEUTRAL] And there is a $500 per covered person per calendar year outpatient deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when the claim is submitted to us for review, we will also have to have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well, and then once the claim has been reviewed, we do have a portal in which claim status can be checked and access to the explanation of benefits for APL and our portal website.
[AGENT][POSITIVE] Is going to be secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alrighty, I'll get that information updated. Is there any um authorizations required to this policy?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] No, ma'am, because this is a supplement, there would not be any prior authorization required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's what I needed to know, Ms. [PII], thank you so much.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. So if that is all I can help with, thank you again for calling APL and I hope that you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.