AccountId: 011433970860
ContactId: 13372d40-b6e2-4d32-8b26-b15f2b61563f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369049 ms
Total Talk Time (AGENT): 175192 ms
Total Talk Time (CUSTOMER): 73084 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/13372d40-b6e2-4d32-8b26-b15f2b61563f_20250113T13:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is, uh, [PII] calling from Northside Hospital.
[CUSTOMER][NEUTRAL] And I'm calling to
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I'm calling to check the eligibility of a patient.
[AGENT][NEUTRAL] OK, and you said that your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, I'm so sorry, [PII]. OK, and you're just needing eligibility, no benefits, is that correct?
[CUSTOMER][POSITIVE] Yeah, benefits too.
[AGENT][NEUTRAL] You need eligibility and benefits. Is that correct? Yes, ma'am, I can help you with those things. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you one moment and what is the member's policy number first off please?
[CUSTOMER][NEUTRAL] 0220
[CUSTOMER][NEUTRAL] 3759.
[AGENT][POSITIVE] OK, [PII] thank you one moment.
[AGENT][NEUTRAL] OK, and showing any information that is provided today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And it, OK, so she is.
[AGENT][NEUTRAL] The spouse of the subscriber on the supplemental policy, [PII], the supplemental policy is active with an effective date of [PII]. And what type of benefit information are you needing for her today, inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] Outpatient hospital surgery?
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum is $1500 per covered person per calendar year for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Uh, so no deductible you said?
[AGENT][NEUTRAL] That is correct. This is a supplemental policy to her primary insurance.
[CUSTOMER][NEUTRAL] And only 1500 is allowed.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Is 1500 is the allowed amount?
[AGENT][NEUTRAL] That is the maximum outpatient benefit on the supplemental policy for covered outpatient services per calendar year.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] And then [PII], because this is a supplemental policy to her primary insurance when the claim is filed with APL, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And then once we have processed our claim, claim status and the EOB for APL can be accessed by going to our portals at secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm hold on let me see the address.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What is your claim's address?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And which network is the, is insurance you?
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Is um um Northside Hospital is in-network with your insurance?
[AGENT][NEUTRAL] There isn't, there is no network with the supplemental policy. It would follow her primary insurance.
[CUSTOMER][NEUTRAL] OK. OK. And uh 1500 is the allowed amount?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, that is the maximum benefit amount.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] Thank you. And uh may, uh, you said your name is [PII], right?
[AGENT][NEUTRAL] Yes, ma'am, I did. Uh-huh.
[CUSTOMER][NEUTRAL] But the initials.
[AGENT][NEUTRAL] And my name?
[AGENT][NEUTRAL] Uh-huh. The initial to my last name is [PII] and my name along with today's date showing will be your call reference number.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You are very welcome. And is there anything else that I can help you with?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] OK, well then, thank you again for calling APO and I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.