AccountId: 011433970860
ContactId: 00c5c3d9-c71f-4001-ac45-0abb3699b9e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240240 ms
Total Talk Time (AGENT): 139145 ms
Total Talk Time (CUSTOMER): 62260 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/00c5c3d9-c71f-4001-ac45-0abb3699b9e9_20250502T17:08_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 [PII], I'm calling because I need benefits on um.
[CUSTOMER][NEUTRAL] A member who's having a procedure done, please, and if you don't mind, can I have the initial of your last name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh thank you.
[AGENT][NEUTRAL] Yes, ma'am. And you're needing benefit information. Do you also need eligibility or just benefits?
[CUSTOMER][NEUTRAL] Both, yeah, both.
[AGENT][POSITIVE] Yes, I can help you with both and who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII], that's [PII]
[AGENT][NEUTRAL] Thank you. And the first initial to your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And what is a good callback for you, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 02216497ML8
[AGENT][NEUTRAL] OK thank you give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information you send me that I do provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on the supplemental policy and it is active with an effective date of [PII]. And give me just one moment and I'll give you the benefit information.
[AGENT][NEUTRAL] And this is outpatient. Oh, you're welcome for facility, is that correct? Or?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be for an outpatient surgery center, ambulatory service center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum per calendar day for covered outpatient services and the benefit amount is $200.
[AGENT][NEUTRAL] And then there is no outpatient deductible per calendar day.
[AGENT][NEUTRAL] Because this is a supplement to.
[CUSTOMER][NEUTRAL] OK, so after the $200 you'll be responsible.
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh I see OK.
[AGENT][NEUTRAL] Yes, ma'am. And because
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] No ma'am, go ahead with your question.
[CUSTOMER][NEUTRAL] Oh no, I just wanted to know the reference number for our call.
[AGENT][NEUTRAL] It's gonna be my name along with today's date.
[AGENT][NEUTRAL] And because this is a supplement to her primary insurance, when the claim is submitted to us, just sending it for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here we do have a portal in which you should be able to check claim status and that website for the portal.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] is [PII].
[CUSTOMER][NEUTRAL] OK, so the 200 per calendar day.
[AGENT][NEUTRAL] It's the maximum benefit for covered outpatient services.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK perfect OK thank you.
[AGENT][NEUTRAL] On the supplemental policy. Well, you're very welcome. So again, is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] No [PII], thank you so much for your help you have a great day.
[AGENT][POSITIVE] Well, I hope you have a great day as well and a nice weekend and thank you again [PII] for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Yes, ma'am.