AccountId: 011433970860
ContactId: 15ec3197-aacf-480e-ae2e-799483cf2083
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266380 ms
Total Talk Time (AGENT): 143866 ms
Total Talk Time (CUSTOMER): 51630 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/15ec3197-aacf-480e-ae2e-799483cf2083_20250228T15:39_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], good morning. I'm calling from Texas Healthcare Imaging, and I'm trying to get benefits on a patient that's here for a [PII]
[AGENT][NEUTRAL] OK, you need, do you also need eligibility or only benefits?
[CUSTOMER][NEUTRAL] Yes, eligibility also that.
[AGENT][POSITIVE] Yes, ma'am. I can help you with both. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, uh.
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] 338-404
[AGENT][NEUTRAL] OK, now that is not an American public life policy number.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Is that the company you were trying to reach? You said 338-404?
[AGENT][NEUTRAL] OK, wait. OK, so give me.
[CUSTOMER][NEUTRAL] What, no, I'm sorry, 186.
[AGENT][NEUTRAL] OK, hold on one second then. 186.
[CUSTOMER][NEUTRAL] 884-3.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] OK, and any 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?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And again, this is for outpatient that you're needing benefit information, is that correct? OK.
[CUSTOMER][NEUTRAL] Yes ma'am, yes, outpatient. She's coming in for a CT.
[AGENT][NEUTRAL] OK, so her outpatient benefit maximum per calendar year for covered outpatient services is $2550 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a, I'm sorry, go ahead with your question.
[CUSTOMER][NEUTRAL] OK, let's just.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] So then she is covered at 100%.
[AGENT][NEUTRAL] Again, I can't guarantee payment. I can only provide you what her benefits are on the supplemental policy. We'll have to receive the claim for review first.
[CUSTOMER][NEUTRAL] OK, and the 200.
[AGENT][NEUTRAL] And because it is a supple.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am. Go ahead.
[CUSTOMER][NEUTRAL] The 2550 is her.
[AGENT][NEUTRAL] Benefit maximum, that's her benefit maximum on this plan with no deductible.
[CUSTOMER][NEUTRAL] Out of pocket or do you just
[CUSTOMER][NEUTRAL] Be me.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Now you will also need to send us a copy of her primary insurance company's explanation of benefits along with the claim for review. We do have to have that. And then once we have processed our claim here at APL Unice, we do have a portal that you all should be able to check our claim status and have access to our EOBN and that website is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And is there anything else?
[CUSTOMER][NEUTRAL] And can I have a reference number for this?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Great, thank you so much for your help, [PII] have hope you have a great day.
[AGENT][POSITIVE] Well, you're certainly welcome.
[AGENT][POSITIVE] I hope you did too, [PII], and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.