AccountId: 011433970860
ContactId: 27d3e813-f46a-4950-ac5b-7b38939e2fe1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223179 ms
Total Talk Time (AGENT): 123622 ms
Total Talk Time (CUSTOMER): 39658 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/27d3e813-f46a-4950-ac5b-7b38939e2fe1_20250107T13:50_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the University of Miami. I wanted to verify if the patient is still eligible and uh get some benefits.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits for member, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, OK, I can help you with those things and I'm so sorry, but I was not able to hear your name at the beginning of the call.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It'll be [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] That the policy number, give me one.
[CUSTOMER][NEUTRAL] Yeah, OK, the policy number I have is 01848604.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] And [PII], 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] OK, so the name we have [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] So I did say that she is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And this is a supplemental policy to her primary insurance [PII] that helps with co-pays, deductibles and co-insurance amounts of coverage services. So what type of benefit information are you needing? inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It would be um outpatient.
[AGENT][NEUTRAL] Outpatient? OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so on this excuse me, on this policy, the outpatient benefit maximum is $500 per covered person per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And because this is a supplement Jam to her primary insurance when the claim is submitted to APL, we must also have a copy of the primary insurance company's explanation of benefits as well for review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we do have a portal that once our claim has been processed that you can check claim status and have access to the EOBs for APL and our website for that is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be all.
[AGENT][POSITIVE] OK, well then if that's all I can help you with, thank you again for calling APL and I hope that you have a great day.
[CUSTOMER][POSITIVE] I thank you, same to you.
[AGENT][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] Bye bye.