AccountId: 011433970860
ContactId: 3773bbb0-81d9-4a63-9e74-7c180ace9997
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265339 ms
Total Talk Time (AGENT): 125312 ms
Total Talk Time (CUSTOMER): 47729 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/3773bbb0-81d9-4a63-9e74-7c180ace9997_20250128T13:07_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. Um, I'm just calling to verify a patient's insurance.
[AGENT][NEUTRAL] OK, so are you needing just eligibility or do you also need benefit information?
[CUSTOMER][NEUTRAL] Um, I need eligibility and ER benefits.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 022 03959 ML 7
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments to get the member's information pulled up please.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, I see, 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 and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I do show that he is the.
[AGENT][NEUTRAL] 11 2nd.
[AGENT][NEUTRAL] OK, so he is the spouse of the subscriber?
[AGENT][NEUTRAL] And the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that you were needing emergency room?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] On an out on his outpatient benefit, the maximum is excuse me, the maximum outpatient benefit per calendar year per covered person for covered outpatient services is $6000 and there is no emergency room deductible per covered person per occurrence.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When the claim is submitted to APL [PII] for our review, we will also have to have a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once our claim has been processed, we do have a portal that you should be able to check claim status in and that portal website for that is secured. [PII].
[CUSTOMER][NEUTRAL] OK, and did he use any of the 6000 in a year?
[AGENT][NEUTRAL] and you are speaking about this calendar year?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] As of now, there have not been any benefits used for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you so much.
[AGENT][POSITIVE] Well, you are very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. I appreciate it. Thanks, [PII].
[AGENT][POSITIVE] OK, [PII], well, you're welcome and thank you again for calling [PII]. I hope you have a very nice day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.