AccountId: 011433970860
ContactId: 26df4a4c-c4df-4eca-bd71-25f3601a9b08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262380 ms
Total Talk Time (AGENT): 140744 ms
Total Talk Time (CUSTOMER): 72312 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/26df4a4c-c4df-4eca-bd71-25f3601a9b08_20250606T13:47_UTC.wav
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[AGENT][POSITIVE] Good excuse me. Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits and eligibility please for one of our partic patients.
[AGENT][NEUTRAL] OK, I'm so sorry. I can barely hear you. There's some background noise that's making it a little difficult. Can you please repeat what you said?
[CUSTOMER][NEUTRAL] No problem. Uh, yes, I'm calling for benefits and eligibility please for one of our patients. My name is [PII]
[AGENT][NEUTRAL] OK, you're needing.
[AGENT][NEUTRAL] OK, [PII], you're needing an eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please Mlka.
[CUSTOMER][NEUTRAL] 016117
[CUSTOMER][NEUTRAL] 60 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] not.
[AGENT][NEUTRAL] And they'll say any information that I provide will be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's gonna be [PII], and it's [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on the supplemental policy and it is active with an effective date of [PII], and what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office and outpatient, please.
[AGENT][NEUTRAL] OK, so on this policy, if it's for an office visit, office visits are not covered.
[CUSTOMER][NEUTRAL] And it's for and, and also outpatient surgery, please.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][MIXED] Yeah, she's nice and stuff but that's.
[AGENT][NEUTRAL] And the outpatient benefit maximum on this policy for covered services is $1500 per calendar year and there is no outpatient deductible.
[CUSTOMER][NEGATIVE] No, no, no, no.
[CUSTOMER][NEUTRAL] Only yeah yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And [PII], I, I can check that for you and as you know, um,
[CUSTOMER][NEUTRAL] How much has been accumulated?
[AGENT][NEUTRAL] When the claim is submitted to APO for review, we will also have to have a copy of the primary insurance company's explanation of benefits along with that claim.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Give me just a moment and I'll give you the amount that's been accumulated so far.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] So for this calendar year as of now, $448.86 has been used.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have a great rest of your Friday and have a good weekend.
[AGENT][POSITIVE] Yes ma'am, you're welcome. uh.
[AGENT][NEUTRAL] I hope you do too, [PII] and then one last thing, I know that you should already have this information too because I speak to you a lot, but we do have our portal for you all to be able to check claim status in once the claim has been processed and that website is [PII].
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] Perfect. Thank you so much. You have a great rest of your day, [PII], OK?
[AGENT][NEUTRAL] Well, you
[AGENT][POSITIVE] I hope you do too, [PII]. It was nice speaking to you and I hope you have a wonderful weekend. Thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Uh-huh. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.