AccountId: 011433970860
ContactId: 0c30bd1f-cb9d-4ee5-9dab-a463b7de0eff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217839 ms
Total Talk Time (AGENT): 109049 ms
Total Talk Time (CUSTOMER): 52826 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/0c30bd1f-cb9d-4ee5-9dab-a463b7de0eff_20250305T19:34_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], my name is [PII]. I'm calling from Associates and Advanced Maternal fetal medicine. I need to get eligibility and benefits for a mutual patient, please.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits, is that correct?
[CUSTOMER][POSITIVE] Yes, yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things and I'm so sorry. What was your first name again?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, [PII], thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] It is 022-91433 M as in Mary, L as in love, 7.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, 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, please, and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII] is her last name. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. 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].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It would be for outpatients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy her outpatient benefit max per calendar year for covered outpatient services is $1500 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And because this is a supplemental policy to her primary insurance, when the claim is submitted to APO for review talk, we will also have to have a copy of the primary insurance company's explanation of benefits as well. And then once we have processed our claim here at APO, we do have a portal that you should be able to check claim status in, and that portal website is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect
[CUSTOMER][NEUTRAL] And has she met anything towards that $1500 limit?
[AGENT][NEUTRAL] As of now she has not for this calendar year.
[CUSTOMER][POSITIVE] Alrighty perfect and lastly just the reference number of this conversation, [PII].
[AGENT][NEUTRAL] Yes, and you would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome so if again, if that is all I can help you with, thank you so much for calling APL and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Likewise thank you bye bye.
[AGENT][NEUTRAL] Um bye-bye.
[CUSTOMER][NEUTRAL] OK