AccountId: 011433970860
ContactId: 10f3aad2-34b7-4c6c-bec3-f96aad7b8706
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287470 ms
Total Talk Time (AGENT): 156029 ms
Total Talk Time (CUSTOMER): 66878 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/10f3aad2-34b7-4c6c-bec3-f96aad7b8706_20250609T20:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. 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 the Brisma Health OBGYN Center. We have a patient that's coming tomorrow, and I just need to verify benefits.
[AGENT][NEUTRAL] OK, [PII], you're only needing benefits. You do not need eligibility. Is that correct?
[CUSTOMER][NEUTRAL] Uh, and also eligibility, yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with both. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] OK, it is.
[CUSTOMER][NEUTRAL] 02493354.
[AGENT][POSITIVE] OK, [PII], thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, [PII], any information provided again will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So now the policy number you gave me is no longer active. It termed as a [PII], but she does have another policy that is active with a different number. So the current active policy number is going to be 262.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 0612.
[AGENT][NEUTRAL] And that again has an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me just one moment, [PII] to get that information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and again what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] That's, this is gonna be an office visit and it's outpatient.
[AGENT][NEUTRAL] OK, so now on the supplemental policy, office visits are not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If she were to receive some form of treatment in the office, that is something that could be reviewed under her outpatient benefit.
[AGENT][NEUTRAL] But the office says it is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need her outpatient?
[CUSTOMER][NEUTRAL] Let me get that in.
[CUSTOMER][NEUTRAL] Uh yes, please. Mhm.
[AGENT][NEUTRAL] Information.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum of $6750.
[AGENT][NEUTRAL] Per calendar year for covered outpatient services and on the supplemental policy, there is an outpatient deductible of 1500 per calendar year per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Now, if you all end up filing a claim with us for her, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL Carina we have a portal that you should be able to check claim status in.
[AGENT][NEUTRAL] And the website for our portal is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, [PII], I have all the information that I need. um, may I have a reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am, you will actually use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect, got it.
[AGENT][POSITIVE] OK. Well, is there anything you're certainly very welcome. It's my pleasure. Is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] Appreciate that, OK?
[CUSTOMER][POSITIVE] No, that'd be all. You have a wonderful afternoon, OK?
[AGENT][POSITIVE] I, I hope you do too, and thank you as well for calling APL.
[CUSTOMER][POSITIVE] Thank you, [PII] bye bye.
[AGENT][POSITIVE] Uh-huh. You're welcome. Bye-bye.