AccountId: 011433970860
ContactId: 157446bd-b728-4e53-bc06-433deb4f2cf0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265299 ms
Total Talk Time (AGENT): 121458 ms
Total Talk Time (CUSTOMER): 47408 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/157446bd-b728-4e53-bc06-433deb4f2cf0_20250331T17:58_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from the Midtown Women's Center in regards to uh mutual patient. Um, I was calling to get outpatient benefits for them.
[AGENT][NEUTRAL] OK, [PII], you're needing to get outpatient benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are you also needing eligibility or just the benefits?
[CUSTOMER][NEUTRAL] Eligibility also.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with both things. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy, please.
[CUSTOMER][NEUTRAL] 01823113 M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] Thank you, one moment please while I get the member's information I pulled up.
[AGENT][NEUTRAL] The 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, please?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the subscriber on the supplemental policy and the supplemental policy is active.
[AGENT][NEUTRAL] With an effective date of [PII].
[AGENT][NEUTRAL] And again, you said that you were needing outpatient benefits?
[CUSTOMER][NEUTRAL] Yes, what was the year of the eligibility? Sorry, I cut out.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. And you did say outpatient benefit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so she has an outpatient.
[AGENT][NEUTRAL] That maximum of $500 per day for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK perfect and then can I just have a reference number for the call please?
[AGENT][NEUTRAL] Sure, yes, ma'am, and just a couple of additional pieces of information for you, [PII]. uh, when the claim is submitted to APL for review.
[AGENT][NEUTRAL] You, we will also have to have a copy of our primary insurance explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have pro.
[AGENT][NEUTRAL] That the claim we also have a portal in which you should be able to change status.
[AGENT][NEUTRAL] And our portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And for your reference number, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, your name is [PII], correct?
[AGENT][POSITIVE] [PII], yes ma'am, that is correct.
[CUSTOMER][POSITIVE] OK, thank you for your help.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be all, thank you.
[AGENT][POSITIVE] OK, well thank you again then for calling APL and I hope.
[CUSTOMER][POSITIVE] Thank you bye bye.