AccountId: 011433970860
ContactId: 32bf96c3-da0b-433b-8d45-e5baa8bdb108
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281829 ms
Total Talk Time (AGENT): 154568 ms
Total Talk Time (CUSTOMER): 91940 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/32bf96c3-da0b-433b-8d45-e5baa8bdb108_20250227T14:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling to check benefit for the patient, please.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] [PII] or [PII] OK, thank you.
[CUSTOMER][POSITIVE] Yes, no, yeah, you're welcome.
[AGENT][NEUTRAL] OK, [PII]. All right, thank you. And my name is [PII] Mhm.
[CUSTOMER][NEUTRAL] Oh, [PII], OK, OK, thank you.
[AGENT][NEUTRAL] Uh-huh. And so again, you're needing to check, tell me again.
[CUSTOMER][NEUTRAL] I'm calling to check benefit please for the patient, mhm.
[AGENT][NEUTRAL] Benefits.
[AGENT][NEUTRAL] OK. Do you also need eligibility, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] I got here 02216489 M letter L and number 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And JD, any information that is provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, her date of birth is [PII]. Her last name is [PII], and the first name is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the subscriber on the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, to which inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, both inpatient and outpatient.
[AGENT][NEUTRAL] OK, so the inpatient calendar year maximum benefit is $1000 per covered person with no inpatient deductible. The outpatient benefit max for covered outpatient service is $200 per calendar day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar date.
[CUSTOMER][NEUTRAL] OK, and then for the inpatient, the $1000 do you have the accumulations?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And uh this is for this calendar year that you're needing information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And as of now on this policy, there have not been any benefits used for this calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then under the $200.
[CUSTOMER][NEUTRAL] Uh, outpatient per day, per calendar day and uh there is cover office procedure.
[AGENT][NEUTRAL] Her calendar day. Mhm.
[AGENT][NEUTRAL] Office procedures can be reviewed. She does have an office treatment writer. Office visits are not covered.
[CUSTOMER][NEUTRAL] OK perfect can you give me a reference number for this uh.
[AGENT][NEUTRAL] Yes, ma'am, and just a couple of additional things, [PII]. When claims are submitted on this type of policy, the APL, we must also receive a copy of her primary insurance company's explanation of benefits along with the claim. And then once we have processed our claims, we do have a portal which you should be able to check our claim status in and have access to our EOBs by going to secured.
[CUSTOMER][NEUTRAL] Insurance
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you for the information.
[AGENT][POSITIVE] Oh, you're very welcome. So again, is there anything else that I can help you with at the moment?
[CUSTOMER][POSITIVE] No, thank you so much, just a reference number.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Sure, [PII]. You're gonna use my name along with today's date.
[CUSTOMER][POSITIVE] Today, thank, thank you [PII].
[AGENT][POSITIVE] All right. Well, you're very welcome. And again, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye-bye.