AccountId: 011433970860
ContactId: 39b54643-2c3c-4e44-88cd-fbdec5801029
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261298 ms
Total Talk Time (AGENT): 126015 ms
Total Talk Time (CUSTOMER): 60092 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/39b54643-2c3c-4e44-88cd-fbdec5801029_20250415T20:02_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits and eligibility please for one of our patients.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Um, it's gonna be 02554490 M as in Mike, L as in Lima.
[AGENT][NEUTRAL] OK, thank you, M. one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information that I do provide for you 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] It's gonna be [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I do show [PII] that she is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient in office, please.
[AGENT][NEUTRAL] OK, so office visits under this policy, OK, are covered under the outpatient benefit and one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $7900.
[AGENT][NEUTRAL] Per covered person and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and how much has been accumulated?
[AGENT][NEUTRAL] As of now, but she has not used any of her benefits for this calendar year.
[CUSTOMER][NEUTRAL] And after the visit?
[AGENT][NEGATIVE] Again, no benefits have been used for this calendar year.
[CUSTOMER][NEUTRAL] But for, for, um for office visits, it's also applied?
[AGENT][NEUTRAL] Office visits would fall under.
[AGENT][NEUTRAL] The outpatient benefit.
[AGENT][NEUTRAL] It's not a number of visits, it just falls under that outpatient benefit maximum.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK, perfect. So it's office visit and the procedure outpatient surgery. The plan will pay up to $7900 per calendar year. 0 has been accumulated.
[AGENT][NEUTRAL] Right, for covered outpatient services and I believe you already know this other information, [PII], but we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And then we have our portal that you should be able to check claim status and once we've processed our claim, and that website for that is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. And the reference number, please?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] And your name sorry?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have a great rest of your, your too, OK?
[AGENT][POSITIVE] Well, you're welcome. Yes, ma'am. You too, though. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No thank you you have a great one moment.
[AGENT][POSITIVE] OK, well, I hope you do too, and it was nice talking to you and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you.