AccountId: 011433970860
ContactId: 39df4604-a374-4957-8301-e1307716817a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304390 ms
Total Talk Time (AGENT): 123351 ms
Total Talk Time (CUSTOMER): 79381 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/39df4604-a374-4957-8301-e1307716817a_20250110T18:22_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 [PII], good afternoon. My name is [PII]. I'm calling from Baptist Outpatient Services. I am calling because I have a patient. I just wanted to check the calendar year amount and remaining balance as an outpatient. Um, I'm not quite sure if they are currently active as well, so I would also need eligibility.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII]. And you did say [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK, and you're needing eligibility and benefit information if the member is still active, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, I can help you with those things and what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Sorry, it is 02145414 M as in Mike, L as in Lima, 8. The name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment please.
[AGENT][NEUTRAL] OK, and what is her date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is um.
[CUSTOMER][NEUTRAL] Sorry, allow me one second.
[CUSTOMER][NEUTRAL] It was, uh, it is [PII] [PII] can, yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, thank you, and any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. So I do show that she is the subscriber on the supplemental policy, and this policy is active. It has an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And her outpatient benefit maximum.
[AGENT][NEUTRAL] Is $8000 per covered person per calendar year for covered outpatient services and there is no outpatient deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're wanting to know if she's used any of that for this calendar year?
[CUSTOMER][NEUTRAL] Yeah, so, um, what is remaining?
[AGENT][NEUTRAL] For this calendar year, is that correct for [PII]? OK, just one moment.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEGATIVE] And for this calendar year, as of now, she has not used any of the benefits.
[CUSTOMER][NEUTRAL] So she still has 8000 remaining?
[AGENT][NEUTRAL] As of now she does.
[CUSTOMER][POSITIVE] Perfect. Um, thank you so much, [PII]. Can I please have your last initial and a reference number for the call?
[AGENT][NEUTRAL] Yes, the first initial to my last name is [PII].
[AGENT][NEUTRAL] You will use my name along with today's date, [PII], as your call reference number and then just a couple of additional things. You may already be aware of these things, but because this is a supplemental policy, we will have to have a copy of her primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we do have our portal in which our claim status can be checked and you can have access to the EOB for APL by going to secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect thank you so much, [PII] um have a great day.
[AGENT][POSITIVE] OK, well, you're very welcome. Yes, ma'am, you too. And if that's all I can help you with then thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Um, bye-bye.