AccountId: 011433970860
ContactId: 3c8b6a98-e33b-4260-b4f9-fe12b2a31ba1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215539 ms
Total Talk Time (AGENT): 114630 ms
Total Talk Time (CUSTOMER): 51882 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/3c8b6a98-e33b-4260-b4f9-fe12b2a31ba1_20250328T18:20_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, good afternoon, [PII]. I call you to verify eligibility and outpatient benefits for the patient, please.
[AGENT][NEUTRAL] OK, you're needing eligibility and outpatient benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things, and who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII] last initial.
[AGENT][NEUTRAL] Yes, sir. Thank you. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] 01666110.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And affiliate, 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 their date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh, I get
[CUSTOMER][POSITIVE] I got you
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And you said that you're needing benefit information, is it for inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient benefits.
[AGENT][NEUTRAL] Outpatient benefits, OK, so the outpatient benefit max for covered outpatient services is $500 per calendar day per covered person.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][POSITIVE] OK, perfect. So $500 per day, correct?
[AGENT][NEUTRAL] Per calendar day, yes, ma'am, for covered outpatient services, and I believe that you already know the next couple of things that I'm gonna tell you that um when the claim is submitted to APL for review, we will have to have a copy of the primary insurance company's explanation of benefits also for review.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then we have our portal for you all to check claim status and once we've processed our claim by going to [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, thank you. Any reference number?
[AGENT][POSITIVE] Yes ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] And the initial of your last name, [PII]?
[AGENT][NEUTRAL] Uh yes, ma'am, [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. I appreciate your help, OK?
[AGENT][POSITIVE] You, yes, ma'am. You're welcome. And is there anything else I can help you with today?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] You too you too thank you bye bye.
[AGENT][POSITIVE] Yes, thank you as well. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.