AccountId: 011433970860
ContactId: 3e8a3898-73c3-4185-b206-977e9cf4c9e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256220 ms
Total Talk Time (AGENT): 137803 ms
Total Talk Time (CUSTOMER): 83936 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/3e8a3898-73c3-4185-b206-977e9cf4c9e2_20250106T19:31_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm trying to get outpatient benefits for our member.
[AGENT][NEUTRAL] OK, you're needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] 1266179 ML 8.
[AGENT][NEUTRAL] 1266179.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Uh, or you can come up to the service and all I have to do is provide.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] credit number or
[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 the patient's name and date of birth?
[CUSTOMER][NEUTRAL] And if you can
[CUSTOMER][NEUTRAL] [PII], her date of birth is, hold on, let me close out of the screen.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So on this policy number you gave me, she had been a subscriber, but this is an old policy. This policy was active from [PII].
[CUSTOMER][NEUTRAL] OK, does she have another yeah.
[AGENT][NEUTRAL] Um, let me see, she's got another policy.
[AGENT][NEUTRAL] She does, so give me just a moment.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] With the
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Oh yeah
[CUSTOMER][NEUTRAL] Are you gonna be doing.
[AGENT][NEUTRAL] OK, so the currently active policy, [PII] is 02579028. What's an effective date of [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] to 3300 so you're here.
[AGENT][NEUTRAL] And again, what type of benefit information were you needing on this policy inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] outpatient.
[AGENT][NEUTRAL] Outpatient, OK.
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] Outpatient benefit maximum on this currently active policy is $6500 per covered person per calendar year for covered outpatient services, and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] And then on top of that, on, on top of that is.
[CUSTOMER][NEUTRAL] that we also go it's for a diagnostic.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] And because this is a
[CUSTOMER][NEUTRAL] OK, and she still has that full amount?
[AGENT][NEUTRAL] Let me see if we've received a claim for data service yet for this calendar year.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEGATIVE] As of now, I, we have not received anything for this calendar year, yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] When the claim is submitted to APL, we will have to receive a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] But I wanted I don't I don't.
[AGENT][NEUTRAL] Along with the claim and then we do have a portal in which you can check our claim status and have access to the EOB and that website is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] and.
[CUSTOMER][POSITIVE] OK perfect. [PII] thank you very much for your help.
[AGENT][POSITIVE] OK, and is there anything else? Absolutely. You're welcome. Can I help you with anything else at Usha?
[CUSTOMER][POSITIVE] No, that's it thank you have a good one.
[AGENT][POSITIVE] OK, you too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm bye.
[AGENT][NEUTRAL] Bye bye.