AccountId: 011433970860
ContactId: 36a5a6be-ee4b-4a8b-9bef-50f8aefb3bb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250300 ms
Total Talk Time (AGENT): 118451 ms
Total Talk Time (CUSTOMER): 84670 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/36a5a6be-ee4b-4a8b-9bef-50f8aefb3bb3_20250415T19:00_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling from the provider's office for checking on an eligibility and benefit status for the patient.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits for one member, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] is a direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, yes, just give me a second for that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The mem uh thank you. The member ID is uh
[CUSTOMER][NEUTRAL] 02299179 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and any information that I do provide for you, [PII], will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, the patient's full name is [PII]. [PII] is the patient's date of birth.
[AGENT][NEUTRAL] Thank you. So this, they are the subscriber on this policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit, yes, ma'am. And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] Uh, I'm checking for the deductible amount for the outpatient. Before that, can you please help me with the group number for this patient?
[AGENT][NEUTRAL] The group number is 20563.
[CUSTOMER][NEUTRAL] 63. OK. And ma'am, is the name's mailing address [PII]?
[AGENT][NEUTRAL] That is correct. [PII].
[CUSTOMER][NEUTRAL] Oh, and this, uh, as you mentioned, it's a supplementary gap policy, right?
[AGENT][NEUTRAL] That is correct. So when the claim is submitted to APL for review, we will also have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] Uh, thank you so much for this information, ma'am.
[AGENT][NEUTRAL] And then once
[AGENT][NEUTRAL] You're welcome. And then once we process the claim, [PII], we do have a portal that you should be able to check claim status in, and that portal website is located at [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, thank you. And can you also please help me with the uh deductible amount, ma'am?
[AGENT][NEUTRAL] And again,
[AGENT][NEUTRAL] Are you needing benefits for inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Out, outpatient, ma'am.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $2250 and there is no outpatient deductible per calendar year on the supplemental policy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Thank you so much for this information, ma'am. And uh is there any conference number for our call, ma'am?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Thank you so much, ma'am. And again, thank you so much for assisting me today. Have a great day. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Well, I hope you have a great day as well. And if that is all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.