AccountId: 011433970860
ContactId: 1ac0af16-a478-4b79-aa45-bdfc105a4046
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259730 ms
Total Talk Time (AGENT): 141784 ms
Total Talk Time (CUSTOMER): 78654 ms
Interruptions: 6
Overall Sentiment: AGENT=2.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/1ac0af16-a478-4b79-aa45-bdfc105a4046_20250401T12:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Yes, good morning. I'm calling to check eligibility and benefits.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yeahhya.
[AGENT][NEUTRAL] Can you please spell your name for me, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 02565547
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] 92
[AGENT][NEUTRAL] And to hire 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, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so I do show that he is a subscriber on this uh supplemental policy, Ghada, and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh does the patient have any um
[CUSTOMER][NEUTRAL] Yeah, office visit, uh, benefit or outpatient, uh, outpatient surgery. I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so office visits are not covered under the supplemental policy. The outpatient, excuse me.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The outpatient benefit maximum.
[AGENT][NEUTRAL] On this plan, one moment.
[AGENT][NEUTRAL] Is $6000.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Per covered person.
[CUSTOMER][NEUTRAL] How much?
[AGENT][NEUTRAL] The outpatient benefit maximum per covered person per calendar year for covered outpatient services is $6000 with no outpatient deductible.
[CUSTOMER][NEUTRAL] OK, anything has been uh met?
[AGENT][NEUTRAL] I can check that also one moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] 0502.
[AGENT][NEUTRAL] OK, and as of now $253.24 has been used for this calendar year. Now if you all will be filing a claim with this insurance, then you will also have to include a copy of his primary insurance company's explanation of benefits along with the claim for review. And then once we have processed our claim here at APL Jhada.
[CUSTOMER][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Not.
[AGENT][NEUTRAL] We do have a portal in which you should be able to check claim status and our portal website is located at [PII].
[CUSTOMER][NEUTRAL] It be a little I'll.
[CUSTOMER][NEUTRAL] OK perfect and do you have a call reference number?
[AGENT][POSITIVE] Yes ma'am, you will use my name along with today's date.
[CUSTOMER][NEUTRAL] Can I have your name please? OK, thank you.
[AGENT][NEUTRAL] Again, my name is [PII].
[AGENT][POSITIVE] You're very welcome and is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that would be all thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 1