AccountId: 011433970860
ContactId: 16b50c59-810f-4f35-aee4-ec3ccd99e79b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354790 ms
Total Talk Time (AGENT): 153749 ms
Total Talk Time (CUSTOMER): 129187 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/16b50c59-810f-4f35-aee4-ec3ccd99e79b_20250123T16:55_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Um, I, I, uh, I am calling to verify, uh, eligibility and benefits on, um, a couple of siblings.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some eligibility and benefits today. Um, do you mind if I get your name and a good call back number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and my callback number is [PII].
[AGENT][POSITIVE] Perfect. And what is the policy number we want to look at today for the two of them?
[CUSTOMER][NEUTRAL] Um, I am showing 932134.
[AGENT][NEUTRAL] 932134.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, give me a moment to get that pulled up.
[AGENT][NEUTRAL] And would you be able to verify both of them their first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, I have got [PII]'s date of birth is [PII]. [PII]'s date of birth is [PII].
[AGENT][POSITIVE] Perfect thank you very very much um I do see the both of them here they are both current and active with us um.
[AGENT][NEUTRAL] It looks like for each of them, their effective dates are their birth dates.
[AGENT][NEUTRAL] Um, so they'll each match their individual birth dates.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you said you needed benefits as well, Ms. [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah, there, this is their secondary um insurance. I know one's coming in for a well visit, the other one's coming in for a sick visit.
[AGENT][NEUTRAL] OK perfect let me take a look and so I'm assuming outpatient benefits then is that correct? Alright, I do wanna let you know any benefit information I give over the phone is always just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yes, we are, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Um, and I'm getting those benefits pulled up right now.
[AGENT][NEUTRAL] All right, so it looks like.
[AGENT][NEUTRAL] With us they both have an outpatient um benefit of $4000.
[AGENT][NEUTRAL] Per occurrence.
[AGENT][NEUTRAL] Hold on, let me actually pull this up. I.
[AGENT][NEUTRAL] I'm so sorry the snapshot's like not reading easy and I wanna make sure I get you the right information so let me just pull up that document.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yeah, so I'm glad I pulled this up because this reads a lot easier, um, so the maximum outpatient benefit for them is $4000 per person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, they do have an outpatient deductible of $250.
[AGENT][NEUTRAL] Per covered person.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not showing that they have.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Any preventative visits uh coverage?
[AGENT][NEUTRAL] I don't see anything preventative and I'm actually, I'm not showing anything as far as a, a physician's office. I'm showing a hospital ER outpatient surgery, diagnostic testing, and outpatient treatment for mental or emotional disorder and a hospital outpatient facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ew.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so this is basically a policy that if they were to have to be hospitalized and or have some kind of outpatient procedure or situation going on that that's what this is pretty much for so OK well that's.
[AGENT][NEUTRAL] Yeah, and I, every one of them is a little different. Sometimes they are, you know, they'll cover urgent cares or doctor offices, but this one, it doesn't look like I'm showing. I mean, I always recommend submitting a claim. I'd rather have a denied claim than this benefits payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, yeah, oh no, no, I, I'm, I'm not gonna not submit it, you know, but, uh, you then get a denial so that I can explain it to the, the, the patient's parents, you know, we did sub submit it and it is not part of your policy, you know, and have an explanation of benefits, uh, um, you know, as backup for that on it to show if needed that kind of thing, but I just, OK, so they are current and active, it's just most likely.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] On, uh, this situation there's not gonna be, I don't the well visits usually covered at 100%. I don't know what their Blue Cross Blue Shield policy they have as primary is, uh, covering so we'll just, uh, we'll just go from there on that. So alright, well I do appreciate your help and uh I'll make a note of that, OK?
[AGENT][POSITIVE] Yeah, my pleasure and if there's anything else you need Miss [PII], just give us a call.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] Mhm, OK, I will do that. Thank you for your help.
[AGENT][POSITIVE] Hey my pleasure thank you so much you take care and have a wonderful day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] You're welcome you too bye bye.
[AGENT][NEUTRAL] Bye bye.