AccountId: 011433970860
ContactId: 08b50409-b3f4-4fa2-ab71-84804a58f876
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195250 ms
Total Talk Time (AGENT): 99821 ms
Total Talk Time (CUSTOMER): 28098 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=3.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/08b50409-b3f4-4fa2-ab71-84804a58f876_20250124T13:33_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good morning [PII]. My name is [PII]. I'm calling to get outpatient benefits for a member.
[AGENT][NEUTRAL] OK, [PII], you're needing outpatient benefits. Do you also need eligibility or just benefits?
[CUSTOMER][POSITIVE] Yes please.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK. Yes, ma'am, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 01611717
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments, please.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII], 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] with the date of birth of [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Well, I do say that she is the spouse of the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And on this plan, um, the outpatient benefit maximum is $1500 for covered person per calendar year for covered outpatient services and there is no deductible for covered person.
[AGENT][NEUTRAL] Her calendar year.
[AGENT][NEUTRAL] And [PII], because this is a supplemental plan to their primary insurance, when the claim is submitted to APO for review, we must also have a copy of her primary insurance explanation of benefits.
[AGENT][NEUTRAL] And then once we have processed our claim, you should be able to check our claim status by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK, and do they have the full amount available?
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] As of now for this calendar year, there have not been any benefits used.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help.
[AGENT][POSITIVE] Well, you're certainly very welcome. So is there anything else I can help you with?
[CUSTOMER][POSITIVE] That'll be all thank you.
[AGENT][POSITIVE] Well, you're very welcome and thank you again, [PII] for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.