AccountId: 011433970860
ContactId: fd9b24c6-616c-418c-aad1-b572c93f4a2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 176570 ms
Total Talk Time (AGENT): 58160 ms
Total Talk Time (CUSTOMER): 63085 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/fd9b24c6-616c-418c-aad1-b572c93f4a2e_20250410T19:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling from a provider's office hoping to get benefits for a member.
[AGENT][POSITIVE] OK, I can help you with benefits. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] My name is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Um, do you have a policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, it is 1 2nd.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It would be 02262371 M like Mary L like Lima 8.
[AGENT][NEUTRAL] OK, thank you. And the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is this for outpatient benefits?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] This is not a guarantee of payment. It's a basic outline of the policy.
[AGENT][NEUTRAL] Uh, let's show him active and effective [PII].
[AGENT][NEUTRAL] And outpatient.
[AGENT][NEUTRAL] For outpatient benefits, he has $1000 per covered person per calendar year benefit.
[CUSTOMER][NEUTRAL] Her calendar year.
[CUSTOMER][NEUTRAL] And it's still available at the moment?
[AGENT][NEUTRAL] Um, let me see what he's used.
[AGENT][NEUTRAL] Uh, don't show he's used anything so far this year.
[CUSTOMER][NEUTRAL] And then um this would be for a hearing aid purchase, is that covered?
[AGENT][POSITIVE] Um, so they do have a durable me that does cover durable medical equipment.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] Um, I just had another question. So they, they told us they have Aetna as their primary. Do you guys require the, uh, explanation of benefits or the denial?
[AGENT][NEUTRAL] Yes, we do require the explanation of benefits. So whatever primary, um, we will pick up potentially deductible co-insurance, co-pay after primary processes the claim.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] All right, would I just be able to get a reference number for our call today?
[AGENT][NEUTRAL] A reference number is just gonna be my name and today's date.
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Um, yes, sorry, I forgot to ask, is, uh, are we able to file electronically or, uh, should we fax it or mail it in?
[AGENT][NEUTRAL] Um, yes, we have a payer ID. It's 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right awesome thank you so much for your help bye bye.
[AGENT][POSITIVE] Thanks for calling APL. Have a good day.