AccountId: 011433970860
ContactId: 2606b6b2-bb89-4449-a14b-0ebf8abaf941
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347959 ms
Total Talk Time (AGENT): 155437 ms
Total Talk Time (CUSTOMER): 97092 ms
Interruptions: 1
Overall Sentiment: AGENT=2.2, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/2606b6b2-bb89-4449-a14b-0ebf8abaf941_20250506T12:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII] how are you?
[AGENT][POSITIVE] I'm great.
[CUSTOMER][NEUTRAL] Um, I'm calling here today because I, I work for a surgery center, Baptist Health Surgery Center, and we have a patient today that's having surgery, and she just gave us her gap insurance, which is APL, and I wanted to see if if this gap insurance is able to cover her amount.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're wanting to verify eligibility and benefits for a member for outpatient surgery, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, outpatient surgery, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], what is a good callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] The member's policy number is 02518930.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, and just if any information that I do provide for you today will 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] Her name is [PII] and her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so on the supplemental policy, [PII], she has an outpatient benefit maximum of $300 per calendar day for covered outpatient services with no deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] So she has $300 per day.
[AGENT][NEUTRAL] 3, 300.
[CUSTOMER][NEUTRAL] 300 per day.
[AGENT][NEUTRAL] Correct. And because it is a supplemental policy to her primary insurance when the claim is submitted to us for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well along with the claim.
[CUSTOMER][NEUTRAL] Give me one, give me, give me 1 2nd, sorry about that. Give me 1 2nd.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] Hello, sorry?
[AGENT][NEUTRAL] Yes sir. Uh-huh.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Yes, what were you saying treated sorry, that just 300 per day and what else?
[AGENT][NEUTRAL] because it is a supplemental policy to her primary insurance, when the claim is filed with APL for review, we will have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal in which you should be able to check claim status and the website to go to for that is located at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so let's say for example because she's her responsibility is 275 today so she'll be covered for today I'm guessing because it's $300 per day.
[AGENT][NEUTRAL] Again, I
[AGENT][NEUTRAL] Yes, sir, but I can't guarantee payment. I can only provide benefits. It'll be, yeah, but.
[CUSTOMER][POSITIVE] Yeah, yeah, no worries.
[CUSTOMER][NEUTRAL] Yeah, you're providing the, OK, that's fine.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] Um, what is, OK, what is your name?
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you would use my name along with today's date, [PII] as your call reference number if you need one.
[CUSTOMER][NEUTRAL] Can I, [PII]?
[AGENT][NEUTRAL] Correct. I.
[CUSTOMER][NEUTRAL] Alright, and then what's your first initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I put today's date of birth as the reference call correct?
[AGENT][NEUTRAL] No. No, sir. I said my name and today's date.
[CUSTOMER][NEUTRAL] Your name and today's date.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you so much, really appreciate it.
[AGENT][POSITIVE] You're, you're very welcome. And is there anything else, [PII] I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, no, thank you, thank you for this, thank you.
[AGENT][POSITIVE] OK, well then, thank you. You're very welcome and thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You too thank you so much.
[AGENT][POSITIVE] Thank you, uh, you're welcome. Bye bye.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So