AccountId: 011433970860
ContactId: 42204920-780a-4671-9823-a8fb14104c00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227270 ms
Total Talk Time (AGENT): 128501 ms
Total Talk Time (CUSTOMER): 61409 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/42204920-780a-4671-9823-a8fb14104c00_20250428T16:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. Uh, good afternoon, [PII]. Um, it's [PII] from [PII]. I need to verify eligibility and outpatient benefits for the patient, please.
[AGENT][NEUTRAL] OK. And you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK, thank you. And what is your callback number, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And you said that you were needing eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And, um, you gave me that. I'm so sorry. I meant to ask you for the policy number.
[CUSTOMER][NEUTRAL] OK. 02295858.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And [PII], any information provided 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].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Hi [PII]. She is a subscriber on the supplemental policy and it is active, Ophelia with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, outpatient, outpatient benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] She has an outpatient benefit maximum per calendar year for covered outpatient services of $3500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because I, I can check that and while that information is loading, because this is a supplement to her primary insurance, when a claim is submitted to us for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Any accumulation do you see?
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And then once we've processed our claim we do have a portal that you should be able to check our claim status in by going to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And as of now, she has not used any of her benefits for this calendar year.
[CUSTOMER][NEUTRAL] OK thank you um any reference number?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] You you said [PII], correct?
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] And last and last initial, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. I'll appreciate it, OK?
[AGENT][POSITIVE] Well, you're very welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you, very nice. Have a nice day.
[AGENT][POSITIVE] Oh well, I hope you have a wonderful afternoon as well and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Oh, papa.