AccountId: 011433970860
ContactId: 3bd0ea2b-5486-4226-af15-53fdb57c5819
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216649 ms
Total Talk Time (AGENT): 98769 ms
Total Talk Time (CUSTOMER): 62991 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/3bd0ea2b-5486-4226-af15-53fdb57c5819_20250205T15:01_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] Hello, good morning. My name is [PII]. I'm calling from Baptist Outpatient Services. I'm trying to see um what the outpatient benefits are for a patient.
[AGENT][NEUTRAL] OK, [PII], do you only need outpatient benefits or do you also need eligibility as well?
[CUSTOMER][NEUTRAL] Uh, just the benefits, just the available amount that they have.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02542050, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you 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 [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so on this policy, she, and again, just to clarify, you did say outpatient benefits?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max.
[AGENT][NEUTRAL] Of $6000 per covered person per calendar year for covered outpatient services and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and can I know the remaining amount?
[CUSTOMER][NEUTRAL] Has she used any of it?
[AGENT][NEUTRAL] OK, uh, for this calendar year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are you referring to this calendar year? OK, one moment.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] As of now, there have not been any benefits used for this calendar year, [PII]. Now, if you all do file a claim with APL, we will have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you should be able to check claim status in and that portal website is secured. [PII].
[CUSTOMER][NEUTRAL] OK, so she has $6000 per person per calendar year and 0 that has been used. Mhm.
[AGENT][NEUTRAL] For covered outpatient services.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, perfect. Thank you for your help. Can I have a reference number for our call, please?
[AGENT][NEUTRAL] Yes, ma'am. You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] All right, perfect. Thank you so much. Have a good one.
[AGENT][POSITIVE] OK. Well, you, you too, [PII], and thank you again for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thanks. Bye-bye.