AccountId: 011433970860
ContactId: fe28dcaf-8cb6-4fcf-89b4-d874cf9359e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367459 ms
Total Talk Time (AGENT): 108847 ms
Total Talk Time (CUSTOMER): 171194 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/fe28dcaf-8cb6-4fcf-89b4-d874cf9359e1_20250611T13:41_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good morning. This is [PII] calling from provider's office. How are you?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][POSITIVE] Yes, I'm doing well. Thank you for asking.
[AGENT][POSITIVE] Yes, sir, and how can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm looking for the patient eligibility and benefits verification, one of my patients. So, can you help me to verify that information?
[AGENT][POSITIVE] Um, yes, sir. I can assist you with benefits. Could I get a good callback number first just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] direct line, my extension.
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Yeah, sure. Policy number is uh.
[CUSTOMER][NEUTRAL] 1851715. I'm sorry for the background noises I have too many patients on available on my end. So that's why I'm sorry for the inconvenience.
[AGENT][NEUTRAL] Oh, no problem. Um, could you please verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. Patience's first name is uh [PII] and the last name is uh [PII].
[CUSTOMER][NEUTRAL] And the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] There's an office visit.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Thank you. And actually, um, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. So for the outpatient, I need to verify the uh the primary or the secondary for the member plan.
[AGENT][NEUTRAL] This is secondary insurance.
[CUSTOMER][NEUTRAL] OK, got it. And uh what's the plan type for the member?
[AGENT][NEUTRAL] It's Medlink, it's secondary insurance.
[CUSTOMER][NEUTRAL] OK, sir, my, uh, can you please repeat that?
[AGENT][NEUTRAL] Medlik M E D L I N K.
[CUSTOMER][NEUTRAL] Oh, Melink Secondary Insurance site.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got it. And uh as you said that no office visit benefits for this members, right? So SBA considers that the 100% covered by the primary leftover.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] I'm sorry, please repeat the question.
[CUSTOMER][POSITIVE] Yeah, so that means may I consider that the 100% benefits for this member's plan. So no out of pocket office visit coupon there.
[CUSTOMER][NEUTRAL] Individual deductible and out of pocket, correct?
[AGENT][NEUTRAL] We don't cover anything for services provided in the office. That's correct.
[CUSTOMER][NEUTRAL] OK. OK, got it. Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh please let me know if uh plan will cover of Medicare Part B deductible and the co-insurance.
[AGENT][NEUTRAL] No, we don't work with Medicare. This is for private insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you are the secondary from Medicare, correct?
[AGENT][NEUTRAL] No, for a pri.
[CUSTOMER][NEUTRAL] Can you please double check on your end which one?
[AGENT][NEUTRAL] We don't work with Medicare. This is for private insurance, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, got it. So, so just a moment. And please let me know buy and build drugs are covered under the patient plan.
[AGENT][NEUTRAL] What's covered under the patient's plan? I'm sorry.
[CUSTOMER][NEUTRAL] Buy, buy and build drugs.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. No prescriptions are not covered under this plan?
[CUSTOMER][NEUTRAL] OK, got it. And uh to see a specialist PCP referral is required or not?
[AGENT][NEUTRAL] No, authorizations are not required because it's secondary coverage.
[CUSTOMER][NEUTRAL] OK. So, just a moment.
[CUSTOMER][NEUTRAL] Yup. So I have done from my side for the member's verification before we disconnecting. Please verify your last name initial of first letter and the caller number for the documentation purposes. And please spell your first name, so may I note down correctly.
[AGENT][NEUTRAL] OK. Yes, for the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] Last [PII] is [PII] and [PII]?
[CUSTOMER][NEUTRAL] Oh sorry, sorry, just a moment.
[CUSTOMER][NEUTRAL] Yeah. Can you please repeat your name?
[AGENT][NEUTRAL] It's [PII], um, it's spelled [PII].
[CUSTOMER][NEUTRAL] Oh, is that uh VE, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, got it. And uh
[CUSTOMER][NEUTRAL] Your name and the date is the card I may using for that?
[AGENT][NEUTRAL] Yes, that's the call reference number.
[CUSTOMER][NEUTRAL] Just a moment. OK, just a moment. I just start with the, you can be able to give me the call starting time.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Uh, no, we are done from my IV for the verification. Thank you for giving me information. Nice to talk with you. You have a wonderful day and bye-bye for now. Take care.
[AGENT][NEUTRAL] You do the same, [PII] Thank you for calling ATL. Mm bye.