AccountId: 011433970860
ContactId: 059705c4-16fd-45b4-bca7-c515b09b1d3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 177270 ms
Total Talk Time (AGENT): 103866 ms
Total Talk Time (CUSTOMER): 47209 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/059705c4-16fd-45b4-bca7-c515b09b1d3d_20250130T13:07_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] Good morning [PII]. My name is [PII]. I'm calling from South Miami Hospital. I'm trying to verify benefits for an individual, please.
[AGENT][NEUTRAL] OK, you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes. Yes, [PII].
[AGENT][NEUTRAL] OK, yes, ma'am. And you're needing to verify, do you also need eligibility in addition to benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. Oh, just benefits, OK. Yes, ma'am, I can help you with that. And what is your callback number, [PII]?
[CUSTOMER][POSITIVE] Just benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] I have a certificate number 1480509 M as in Mary, L as in Larry 8.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And aligning the 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 their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] uh
[AGENT][POSITIVE] Thank you. So I do so, excuse me, I do show that she is the subscriber on the supplemental policy and it is active with, oh, you said you didn't need that. I'm so sorry.
[AGENT][NEUTRAL] OK, do you need inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Outpatient, outpatient.
[AGENT][NEUTRAL] She has an outpatient benefit maximum of $500 per covered person per calendar day for covered outpatient services and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK, so she's covered. OK. And you have a reference number?
[AGENT][NEUTRAL] And when
[AGENT][NEUTRAL] Yes, you would use my name that I gave you along with today's date and just a couple of additional things. [PII], when the claim is submitted to APL for review, we must also have a copy of her primary insurance company's explanation of benefits as well. And then once we have processed our claim, we do have a portal that you should be able to check claim status and by going to secured. [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK. Well, is there anything? Absolutely. Can I help you with anything else this morning?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] No, that'll be all thank you.
[AGENT][POSITIVE] OK, well then, thank you again for calling APO and I hope that you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.