AccountId: 011433970860
ContactId: 27e899db-6bd6-4bd9-86f4-17dcb438cfd6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268910 ms
Total Talk Time (AGENT): 146109 ms
Total Talk Time (CUSTOMER): 74182 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/27e899db-6bd6-4bd9-86f4-17dcb438cfd6_20250227T13:25_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. I can hardly hear you.
[AGENT][NEUTRAL] Can you hear me better?
[CUSTOMER][POSITIVE] Much better. Thank you.
[AGENT][NEUTRAL] I'm sorry, I don't know my volume on, on my headset has gone down automatically. OK, strange, but OK. Good morning. Well, this is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling from Jason West Medical Center.
[AGENT][NEUTRAL] Yes, I am.
[CUSTOMER][NEUTRAL] I have a patient coming for outpatient procedure and I would like to obtain the benefit for this cap insurance please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And also you're needing to verify eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, please, for outpatient procedure. Mhm.
[AGENT][NEUTRAL] Yes, ma'am. I
[AGENT][NEUTRAL] For outpatient. I can help you with those things. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah you're looking here.
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number, please, Olga?
[CUSTOMER][NEUTRAL] 02556461 ML 8.
[AGENT][NEUTRAL] OK, thank you. One moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Network
[AGENT][NEUTRAL] And although if you're gonna need the first initial to my last name, it's gonna be [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And also over any information that I provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII], last name [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do show that she is the subscriber on this supplemental policy and it is active Oga with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And one moment on my benefits.
[AGENT][NEUTRAL] So she has an outpatient benefit maximum for covered outpatient services per calendar year of $8700 and there is no outpatient deductible for covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so she hasn't used it yet. She has all of the benefits available.
[AGENT][NEUTRAL] I can check that and when the claim is submitted while this is pulling up, yes, as of now she has not used any benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we will also need for you all to send the primary insurance excuse me, the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you should be able to check claim status and have access to our EOBs by going to secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Um, [PII], could I have the address to submit a claim, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Can you repeat the zip code again?
[CUSTOMER][NEUTRAL] I don't know if it's, but you know.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Mm, OK. [PII], could I have a reference number for this call, please?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] OK, thank you for your help. Have a nice one.
[AGENT][POSITIVE] Well, I hope you have a nice day too if that's all I can help you with, thank you again, O for calling APL.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Bye bye.