AccountId: 011433970860
ContactId: 0aded01e-80ae-4370-83ce-a27d102c0bb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 209809 ms
Total Talk Time (AGENT): 110416 ms
Total Talk Time (CUSTOMER): 58610 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/0aded01e-80ae-4370-83ce-a27d102c0bb3_20250227T16:03_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 [PII], I'm calling because I need to get a patients out um outpatient benefits for surgery.
[AGENT][NEUTRAL] OK, you're needing outpatient benefits only. Do you also need eligibility or just the benefits?
[CUSTOMER][NEUTRAL] eligibility as well please.
[AGENT][POSITIVE] Yes, ma'am. I can help you with both. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02556461 ML 8
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I do provide for you this morning, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I do show that she is a subscriber on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And the outpatient benefit max on this policy per calendar year for covered outpatient services is $8700 with no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy, Sandra, to the primary insurance when the claim is submitted to APO for review, you all must send us a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we've processed our claim, we, we have a portal that you should be able to check our claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and um has anything been met towards the outpatient mac?
[AGENT][NEUTRAL] One moment, I can check.
[AGENT][NEUTRAL] As of now, no, ma'am.
[CUSTOMER][NEUTRAL] 0
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Me
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then this would cover um basically deductible and co-insurance or just deductible?
[AGENT][NEUTRAL] This policy is designed to help with co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] And car insurance. OK, perfect. OK, um, may I have a reference number for the call please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am you would use my name along with today's date.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 22725 perfect thank you for your help, [PII].
[AGENT][POSITIVE] Well, you are certainly very welcome. So is there anything else, [PII] I can help with?
[CUSTOMER][POSITIVE] No, that was it thank you.
[AGENT][POSITIVE] OK, well, you're certainly welcome. Thank you again for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Bye thank you bye.