AccountId: 011433970860
ContactId: 0778b976-b038-4063-a724-c81866fb1914
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 222360 ms
Total Talk Time (AGENT): 114780 ms
Total Talk Time (CUSTOMER): 50211 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/0778b976-b038-4063-a724-c81866fb1914_20250225T20:23_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], this is [PII]. I'm calling from the facility to check the benefits of the patients.
[AGENT][POSITIVE] I'm so sorry. What was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, and you're needing to check eligibility and benefits? Is that correct? Yes, ma'am, I can help you with those things. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] A1.
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Um, I have here 01534911 and the letter ML8.
[CUSTOMER][NEUTRAL] The number 8 at the end.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. There was [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that she is the spouse of the subscriber on the supplemental policy and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatients benefits.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum on this policy is $250 per calendar day for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK, so let's say for the patient have a copay of $200 you, um, you pay the copay?
[AGENT][NEUTRAL] This policy is designed to help with co-pays, deductibles, and co-insurance amounts of covered services up to that benefit maximum.
[AGENT][NEUTRAL] And when the claim is submitted.
[CUSTOMER][NEUTRAL] So it'll be $200 you say?
[AGENT][NEUTRAL] The benefit maximum on this plan per calendar day is $250 with no outpatient deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we will have to have a copy of her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] Along with the claim for reviews?
[AGENT][NEUTRAL] And then once we have processed our claim, you all should be able to check our claim status by going to our portal, which is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I see here. OK.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that'll be all. Just do you provide a reference number for the call?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, thank you, [PII], have a nice one.
[AGENT][POSITIVE] Yes, yes, ma'am, [PII], you too, and thank you again for calling APL if that's all I can help you with.
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.