AccountId: 011433970860
ContactId: 08e9e53a-5080-4b2b-9806-c8accc39e617
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232240 ms
Total Talk Time (AGENT): 126114 ms
Total Talk Time (CUSTOMER): 51547 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/08e9e53a-5080-4b2b-9806-c8accc39e617_20250416T18:15_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, good afternoon. I'm calling to check the benefits for patients.
[AGENT][NEUTRAL] OK, you're needing to check benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. Do you also need eligibility or strictly benefits?
[CUSTOMER][NEUTRAL] Um, eligibility and benefits.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with those things. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] 02501744 ML 8.
[AGENT][POSITIVE] OK, [PII], thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I 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] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do say she is a subscriber on the supplemental policy and yes ma'am, it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her ID inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the um outpatient benefit maximum per calendar year for covered outpatient services is $1000 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy ID to the primary health care insurance, when the claim is submitted to APL, we will also.
[AGENT][NEUTRAL] Have to have a copy of the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes ma'am, can you hear me?
[CUSTOMER][NEGATIVE] Yes, I can hear you now, but you cut off.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, so again, any, OK, so when the claim is submitted to APL for review, we will also have to have a copy of our primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For review and then once we've processed our claim here at APL we do have our portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, out of the $1000 yearly, has the patient met anything?
[AGENT][NEUTRAL] As of now, she has used $70 for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get a reference number for the call?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Mm 4 16 2025.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Well, you're welcome. And is again, anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK, well, thank you so much [PII] for calling APL and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.