AccountId: 011433970860
ContactId: 089d8e1e-fcde-4e98-8c30-59eaf801c9ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 187110 ms
Total Talk Time (AGENT): 103023 ms
Total Talk Time (CUSTOMER): 41400 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/089d8e1e-fcde-4e98-8c30-59eaf801c9ef_20250507T12:54_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 morning [PII]. My name is [PII]. I'm calling from Outpatient surgical. I have a patient that's coming into our facility for a procedure and I need to um.
[CUSTOMER][NEUTRAL] Verify benefits please.
[AGENT][NEUTRAL] OK, [PII], you're only needing benefits. You do not need eligibility, is that correct?
[CUSTOMER][POSITIVE] I need both. I'm sorry.
[AGENT][POSITIVE] Yes, I can help you with both then. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] I have 02473213 Mary Larry the number [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, any information that I do provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and your date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. So I do show that he is the subscriber on this supplemental policy, and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And he has an outpatient benefit max per calendar day for covered outpatient services of $300 and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] So daily you pay $300.
[AGENT][NEUTRAL] For covered outpatient services that would be the benefit on this plan. And then because it is a supplemental policy to his primary insurance, we will have to have a copy of the primary EOB along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal [PII] where you should be able to check claim status.
[AGENT][NEUTRAL] And that website is located at secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and where do I mail the claims to?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII]. Have a great day.
[AGENT][POSITIVE] Well, you're welcome. Yes, ma'am, you too. And if that's all I can help you with today, [PII], um thank you again for calling APL.
[CUSTOMER][POSITIVE] Thanks. Bye-bye.
[AGENT][NEGATIVE] A bad.