AccountId: 011433970860
ContactId: 2f2b087a-5cae-4a1e-9608-0e9017f7f839
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268179 ms
Total Talk Time (AGENT): 143439 ms
Total Talk Time (CUSTOMER): 62535 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/2f2b087a-5cae-4a1e-9608-0e9017f7f839_20250218T16:22_UTC.wav
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[CUSTOMER][NEUTRAL] Because your tea
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, good morning. Um, I'm calling for benefits and eligibility, please, of one of our patients.
[AGENT][NEUTRAL] OK, you're needing benefits and eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Of course it's gonna be [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Mhm. It's gonna be 02518380 M as in Mike, L as in Lima H.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. First off, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is gonna be, give me one moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The patient's name is gonna be [PII], and the date of birth.
[CUSTOMER][NEUTRAL] it's gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. [PII], I do need to give you a different policy number for this number because the policy number you gave me um is an old number. So the current active policy number for this number is 02534033.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[AGENT][NEUTRAL] And give me just a moment please to get that information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So I do show that he is the spouse of the subscriber on this policy and again now because this policy is active. Effective date is [PII]. And what type of benefit information are you needing for him, inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, office and outpatient.
[AGENT][NEUTRAL] OK. Now, on this policy, office, is this for an office visit or treatment in the office?
[CUSTOMER][NEUTRAL] It's for an office visit.
[AGENT][NEUTRAL] OK, so on the supplemental policy, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you said that you also needed his outpatient benefits. OK.
[CUSTOMER][NEUTRAL] Outpatient
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So he has an outpatient benefit max per calendar day for covered outpatient services.
[AGENT][NEUTRAL] Of $1500 with no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] And when the claim is submitted to APL for review, we will also need for you to send the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we do have our portal that you should be able to check our claim status and once the claim has been processed by us by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty, perfect. Um, can you provide please a reference number, please?
[AGENT][NEUTRAL] OK. And is there any?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure. You would use my name along with today's date and again, my name is [PII]
[CUSTOMER][POSITIVE] Oh, OK, thank you so much, [PII]. You have a great rest of your Tuesday.
[AGENT][POSITIVE] Well, I hope you do too, [PII], and if that is all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye.