AccountId: 011433970860
ContactId: 029764c6-403c-40b6-bf65-7dc7acf423d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257040 ms
Total Talk Time (AGENT): 109276 ms
Total Talk Time (CUSTOMER): 55512 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/029764c6-403c-40b6-bf65-7dc7acf423d5_20250109T21:11_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi. Good afternoon, [PII]. This is [PII] from Baptist Outpatient Services. I'm a rendering provider in [PII], and I was calling to get benefits on a patient.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], you're only needing to get benefit information. You do not need eligibility only benefits, is that correct? Or do you need both?
[CUSTOMER][NEUTRAL] Well, I'm imagining if you're gonna give me the benefit is because the patient is eligible.
[AGENT][POSITIVE] If you need eligibility as well, yes, ma'am. I'll be happy to provide both of those things for you.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] You're welcome. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] I don't know if it's correct, but it's 0230.
[CUSTOMER][NEUTRAL] 160.
[CUSTOMER][NEUTRAL] 9, M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Excuse me, [PII], about that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is gonna be on [PII], [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so she is the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And you were needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, she's coming in to have the ultrasound.
[AGENT][NEUTRAL] Inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient facility, freestanding independent facility.
[AGENT][NEUTRAL] The outpatient benefit max on the supplemental policy per calendar year for covered outpatient services is $2500 with no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And because this is a supplemental policy to her primary insurance, [PII], we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed the claim with APL you may check claim status and have access to the explanation of benefits by going to our portal.
[AGENT][NEUTRAL] At [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Does she have all $2500 available at the moment?
[AGENT][NEUTRAL] I can check that for you. One moment.
[AGENT][NEGATIVE] As of now, I do not show that any benefits have been used for this calendar year.
[CUSTOMER][NEUTRAL] OK, so she has a group number?
[AGENT][NEUTRAL] Yes ma'am, one moment.
[AGENT][NEUTRAL] The group number is 17,750.
[CUSTOMER][NEUTRAL] OK, and can I get a reference number for our call, [PII]?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Yeah, well, thank you so much have a great day.
[AGENT][NEUTRAL] Well you