AccountId: 011433970860
ContactId: 1971bf17-0689-4aed-b3fc-0ea9194115ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382220 ms
Total Talk Time (AGENT): 169571 ms
Total Talk Time (CUSTOMER): 147882 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/1971bf17-0689-4aed-b3fc-0ea9194115ba_20250519T19:22_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, good afternoon. Uh, my name is [PII], and I'm calling from Boca Regional Hospital Women's Institute. I'm working on the patient that has this insurance, uh, as a secondary, and I want, I, I need to get some information because I don't really know how this insurance works according to the patient, uh.
[CUSTOMER][NEUTRAL] This this insurance will pick uh whatever uh her primary insurance doesn't pay.
[CUSTOMER][NEUTRAL] And I just wanna make sure so I'll put the information in the system.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and benefit information, [PII] for a member, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with those things. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Um, member's policy number what because this is outpatient benefit, uh, would be.
[AGENT][POSITIVE] Yes, and give me that number.
[CUSTOMER][NEUTRAL] Yeah, 01432669.
[CUSTOMER][NEUTRAL] Letter M as in Mary, L as in Larry, number 8.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any information [PII] that I do provide for you 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] OK.
[CUSTOMER][NEUTRAL] Uh, patient's name is uh.
[CUSTOMER][NEUTRAL] [PII] is [PII].
[AGENT][NEUTRAL] OK, so she is covered on the supplemental policy and it is active. Her plan effective date is for [PII].
[AGENT][NEUTRAL] And yes, ma'am, this is a supplement to the primary insurance that helps with co-pays.
[AGENT][NEUTRAL] Deductibles and co-insurance amounts of covered services.
[AGENT][NEUTRAL] So you're needing outpatient benefits for her, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this supplemental policy her outpatient benefit maximum per calendar year for covered outpatient services is $2000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it is a supplemental policy and to her primary insurance, when the claim is submitted to us for review, we must also receive a copy of our primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once the claim has been processed by APL we do have a portal in which you should be able to check our claim status and the website for that portal is located at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, let me repeat it. It's secure [PII]
[AGENT][NEUTRAL] With
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[AGENT][NEGATIVE] Not like the grocery store. Yeah, not like the grocery store like the.
[CUSTOMER][NEUTRAL] I, I just say, oh, just say.
[CUSTOMER][POSITIVE] It's funny, you say public and I wrote [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so is is that OK, secure [PII].
[AGENT][NEUTRAL] secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] got it perfect so they have to submit everything to that or review the claiming status on that uh link.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[AGENT][NEUTRAL] Well, yes, ma'am, right. Once the claim, yes, you all will file the claim and along with sending us our primary insurance explanation of benefits. And then once we have reviewed the claim and it's been processed, yes ma'am, you should be able to check the claim status by going to the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you so much and may I have a uh um reference number for this call?
[AGENT][NEUTRAL] A reference number?
[AGENT][POSITIVE] Yes, ma'am, you will actually use my name along with today's date.
[CUSTOMER][NEUTRAL] And your name again is?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for your help, OK?
[AGENT][POSITIVE] Yes, ma'am. Well, you're certainly very welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] No, that will be all thank you so much thank you have a good afternoon.
[AGENT][POSITIVE] All right. Well, you're welcome. I hope you do too. Thank you, [PII].
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] OK, bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.