AccountId: 011433970860
ContactId: 19c8e575-1a1d-4654-978d-e29936637342
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340369 ms
Total Talk Time (AGENT): 151508 ms
Total Talk Time (CUSTOMER): 74411 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/19c8e575-1a1d-4654-978d-e29936637342_20250623T13:51_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, [PII]. My name is [PII]. I'm calling from Hometown Hospital. I'm trying to verify benefits for a patient, please.
[AGENT][NEUTRAL] OK, [PII], are you needing just eligibility or do you all, I'm sorry, benefits or do you need eligibility as well?
[CUSTOMER][NEUTRAL] Uh, both, please.
[AGENT][POSITIVE] OK. Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] option one.
[AGENT][NEUTRAL] Option one, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Uh, policy number that I have is 01960233 M like Mary L like love 8.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And any information [PII] that I do provide today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient is [PII]. Um, date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so is this for a future data service or a past data service?
[CUSTOMER][NEUTRAL] No, it's for a future date. Um, he's scheduled for tomorrow actually to have a procedure here helps the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So you, so the policy number that you gave me is no longer active, but there is another policy number that is active. The one you gave me actually termed as a 61-2025.
[AGENT][NEUTRAL] And the current active policy is 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 618-77777
[AGENT][NEUTRAL] And it has an effective date of [PII] and he is the subscriber.
[AGENT][NEUTRAL] And what type of benefit information do you need for him again, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No, outpatient hospital, um.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Sorry
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] So on this supplemental policy, uh, [PII], the outpatient benefit maximum per calendar year for covered outpatient services is $1500 per covered insured and there is no outpatient deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Per calendar year and because this is a supplemental policy to the primary insurance when the claim is submitted to us for review, we will also have to have a copy of the primary insurance company's explanation of benefits along with the claim and then once we have processed our claim here at APL we do have a portal that you should be able to check his claim status in by going to secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, um, has, uh, he used any of that 1500 or no?
[AGENT][NEGATIVE] As of now, no, ma'am, no benefits have been used for this calendar year on this policy.
[CUSTOMER][POSITIVE] Perfect. So he still has remaining, so 1500 per calendar year for outpatient benefits, um, and, uh, no authorization is required with.
[AGENT][POSITIVE] As of now. Correct.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK perfect um alright that is all I needed [PII]. Can I just get a call reference number please?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes ma'am, you will actually use my name along with today's date.
[CUSTOMER][NEUTRAL] Um, is it, oh, so [PII], and then what's your last name initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect, um, alright, uh, thank you so much appreciate it have a wonderful day.
[AGENT][NEUTRAL] OK. All right. Well then.
[AGENT][POSITIVE] You're welcome and I hope you have a wonderful day too, [PII]. And if that's all I can help you with, thank you again for calling APL. Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Bye-bye.