AccountId: 011433970860
ContactId: 0850b20a-43b1-466d-b9cf-d05ea82ab9df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239910 ms
Total Talk Time (AGENT): 124268 ms
Total Talk Time (CUSTOMER): 58511 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/0850b20a-43b1-466d-b9cf-d05ea82ab9df_20250303T21:20_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling you from Miami Cancer Institute. I wanted to get uh eligibility and the benefits on a patient's plan, please.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefit information, is that correct?
[CUSTOMER][POSITIVE] Correct. Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with those things, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] We have 224-719-1.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And have any information that I do provide for you today 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].
[CUSTOMER][NEUTRAL] And we have date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] So I do appreciate that Mr. [PII] is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And he had, uh, and you were needing outpatient benefits for him, is that correct?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's correct. I wanted to know what uh would be covered after his um primary insurance.
[AGENT][NEUTRAL] OK, so we will have to receive the claim in order to review that for benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, along with the claim, we will also have to have a copy of his primary insurance company's explanation of benefits for review.
[AGENT][NEUTRAL] As well.
[AGENT][NEUTRAL] And on his supplemental policy, the maximum benefit per calendar year for covered outpatient services, [PII], is $2500 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you tell me if you used any of that, uh, $2,005.
[AGENT][NEUTRAL] The 2 you're wanting to know if he's used any of the 2500 for this calendar year? I can check that for you. One moment.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you. I appreciate it.
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][NEUTRAL] And as of now, no, ma'am, he has not.
[CUSTOMER][NEUTRAL] K. 0 U.
[AGENT][NEUTRAL] Now once we have processed the claim here at APL [PII], we also have a portal in which you should be able to check claim status and our portal website that you would go to is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] All right. And is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Just need a reference number if you provide them.
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] And I'm sorry, can you repeat your name one more time? I didn't write it down.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII], thank you so much, [PII].
[AGENT][POSITIVE] Yes, ma'am. Well, you're very welcome, [PII]. So if that is all I can help you with, thank you again for calling APL and I hope you have a nice evening.
[CUSTOMER][NEUTRAL] Likewise. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.