AccountId: 011433970860
ContactId: 329a4aff-39cf-46f6-9c4b-e63f43e53126
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291119 ms
Total Talk Time (AGENT): 152304 ms
Total Talk Time (CUSTOMER): 65834 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/329a4aff-39cf-46f6-9c4b-e63f43e53126_20250211T20:31_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Baptist Outpatient Services. I need to verify if a patient's plan with you guys is active, please.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], so you're only needing eligibility. You do not need benefits. Is that correct?
[CUSTOMER][NEUTRAL] Well, I need both, yes, I need to see if it's active and how much is remaining in the outpatient.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with both and what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 02106926 M as in Mary, L as in Larry 8.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. Now, she was a subscriber on this policy. Now, this particular policy number that you provided for me is no longer active. It termed as of [PII].
[AGENT][NEUTRAL] Is this for a future data service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, she's scheduled for [PII]. Does she have any other current policy with you guys?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So her current active policy number is different. It's 02556462 with an effective date of [PII].
[AGENT][NEUTRAL] And give me just one moment to get that information pulled up, please.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. So again, this policy is active with an effective date of [PII] and you said that you were needing outpatient benefits for her, is that correct?
[CUSTOMER][NEUTRAL] Yes, that's correct. I'm also gonna need if you can repeat that new policy number. I'm sorry, I hit the wrong button and I erased it.
[AGENT][NEUTRAL] That's OK. 02.
[AGENT][NEUTRAL] 556 462.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max.
[AGENT][NEUTRAL] Per calendar year for covered outpatient services of $8700 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And you're needing to see if she has any accumulations for this year as of now?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEGATIVE] And as of now, no, ma'am, she does not.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] So, and you may already be aware of this, [PII], um, that when the claim is submitted to APL we must also receive a copy of her primary insurance company's explanation of benefits with the claim for review and then once we have processed our claim here at APL, we do have a portal in which you should be able to check claim status and have access to our EOB and that portal website would be secured.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome. So, can I help you with anything else this afternoon?
[CUSTOMER][POSITIVE] No, that's it. If you can just provide me the first initial to your last name and a reference number for the call, that'll be great.
[AGENT][NEUTRAL] The reference number will be my name in today's date and the first initial [PII] to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have a great rest of your day.
[AGENT][POSITIVE] I hope you do too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Mm, bye bye.