AccountId: 011433970860
ContactId: 2a63e1c8-4f13-49ef-8ca2-f84ddccd17fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264029 ms
Total Talk Time (AGENT): 136228 ms
Total Talk Time (CUSTOMER): 54155 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/2a63e1c8-4f13-49ef-8ca2-f84ddccd17fc_20250227T19:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII], good afternoon. Um, I would like to, I'm calling to get eligibility benefits for one of our patients.
[AGENT][NEUTRAL] OK, did you say that you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling from Doctor [PII]'s office.
[AGENT][NEUTRAL] OK, and [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02549483
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, and 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 date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] OK, so again, any information that's provided will be a verification of benefits and not a guarantee of payment. I do show that she is the subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what kind of benefit information do you need, Risa inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office visit, specialist office visit.
[AGENT][NEUTRAL] OK, OK, on this policy, office visits are not covered.
[CUSTOMER][NEUTRAL] Is there an outpatient benefit maximum? How much is it and what's the accumulation?
[AGENT][NEUTRAL] For covered outpatient services, the outpatient benefit max on this policy is.
[AGENT][NEUTRAL] $6000.
[AGENT][NEUTRAL] Per covered person per calendar year.
[AGENT][NEUTRAL] With no deductible?
[CUSTOMER][NEUTRAL] All right. What's the accumulation?
[AGENT][NEUTRAL] And for this calendar year for one moment.
[AGENT][NEUTRAL] And as of now she has used $220.20 of that benefit for this calendar year.
[AGENT][NEUTRAL] If you all do file a claim with APL on this policy, you will also need to include the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once the claim has been reviewed and processed at APL, we do have a portal reason that you should be able to check our claim status and have access to our EOB and the portal website that you would go to is [PII].
[CUSTOMER][NEUTRAL] Uh, what's your name again?
[AGENT][NEUTRAL] [PII] and my name in today's date would be your call reference number if you need one.
[CUSTOMER][NEUTRAL] [PII] and your initial would be?
[AGENT][NEUTRAL] Yes and yours?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Mine is [PII], and what is yours?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII]. That, that's all for me for today.
[AGENT][POSITIVE] OK. Well, that is all I can help you with, [PII], and thank you again for calling APL and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.