AccountId: 011433970860
ContactId: 40e150a7-eaff-4a7c-b477-19fef98b1591
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425779 ms
Total Talk Time (AGENT): 186225 ms
Total Talk Time (CUSTOMER): 83851 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/40e150a7-eaff-4a7c-b477-19fef98b1591_20250206T19:58_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 [PII], good afternoon. This is [PII]. I'm calling in from Baptist Outpatient Services. Just calling in to obtain quick benefits for a patient.
[AGENT][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, [PII]. You did say [PII]. Is that correct? [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is that correct? OK, OK, thank you. And you're needing eligibility and outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yeah, just like that.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and I, what is a good call back number for you?
[CUSTOMER][NEUTRAL] Call back [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 01816250 ML8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] I don't let any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is for uh [PII].
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you. So, one moment please.
[AGENT][NEUTRAL] OK, so she had been covered under this policy, but she is no longer covered as of [PII].
[CUSTOMER][NEUTRAL] As of [PII]. OK. Are you able to check if maybe she's covered under a different policy number or has any other?
[CUSTOMER][NEUTRAL] Um, active plans with this, uh, insurance?
[AGENT][NEUTRAL] Uh, do you have her full social? I can try and search that way, but she.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] I do, actually, yes.
[AGENT][NEUTRAL] OK, so give me just a moment to make my, to make my note on this policy before I can search for anything else.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I guess actually I said 12:[PII] it would have been 12. This policy shows that it became individual coverage effective [PII].
[AGENT][NEUTRAL] So give me just one moment. Mhm.
[CUSTOMER][NEUTRAL] OK, so she, she does have an active policy then?
[AGENT][NEUTRAL] No, I'm saying the policy number you gave me in which she had been covered. I haven't been able, give me just a moment to
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] As of [PII], she was covered under this policy. OK, so one moment.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Actually, you can just say 11.
[AGENT][NEUTRAL] Of [PII]. I'm sorry, we're getting too many years here.
[AGENT][NEUTRAL] This policy is now individual only as of [PII].
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And her social, please?
[CUSTOMER][NEUTRAL] A patient's social is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, I may have located a policy for her.
[AGENT][NEUTRAL] And again, any information that's provided for you, all that would be a verification of benefits and not a guarantee of payment. Uh, what is her date of birth?
[AGENT][NEUTRAL] Again,
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so the policy number for her policy is 02457137.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[AGENT][NEUTRAL] And again for benefits inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, she has an outpatient benefit maximum of $2500 per covered person.
[AGENT][NEUTRAL] Per calendar year for covered outpatient services and there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][POSITIVE] OK. Sounds great.
[AGENT][NEUTRAL] And then all that if you all are gonna be submitting a claim to APL we will also have to have a copy of her primary insurance company's explanation of benefits as well. And once we've processed the claim at APL, you, we do have a portal that you all can check claim status and have access to our EOBs in by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Perfect. Thank you so much.
[AGENT][POSITIVE] All right. Well, you are certainly very welcome. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] That'll be all, thank you.
[AGENT][POSITIVE] OK, [PII]. Well, thank you again for calling APL and I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] You too. Thank you so much.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye.