AccountId: 011433970860
ContactId: 433ec053-06ba-4707-8654-21c38ea016a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303109 ms
Total Talk Time (AGENT): 146467 ms
Total Talk Time (CUSTOMER): 65904 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/433ec053-06ba-4707-8654-21c38ea016a5_20250224T21:13_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 calling to verify uh eligibility for this insurance.
[AGENT][NEUTRAL] OK, you're just needing to verify eligibility. You do not need benefit information, is that correct?
[CUSTOMER][POSITIVE] Yeah, well, actually eligibility and benefits, yes.
[AGENT][POSITIVE] Yes, I can help you with both. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Can you spell your name for me, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, [PII], thank you. And your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the numbers [PII], I'm sorry, [PII]. OK, thank you. OK. And [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] Extension 8263.
[CUSTOMER][POSITIVE] It's OK, you're good. Yeah.
[CUSTOMER][POSITIVE] Yes, it's, I'll give it to you right now. Give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's 024.
[CUSTOMER][NEUTRAL] 65602
[CUSTOMER][NEUTRAL] NL 8.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The name is [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. So on this policy, this policy number is actually no longer active. I'll give you a different policy number. This policy number had an effective date and a term date of [PII], so give me just one moment to locate the correct policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the current policy number that you should have is 2262351.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Inpatient, outpatient or office ER?
[CUSTOMER][NEUTRAL] For the ER.
[CUSTOMER][NEUTRAL] Um, outpatient. Yes.
[AGENT][NEUTRAL] Outpatient, OK. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the outpatient benefit max for calendar year for covered outpatient services is $7900 per covered person.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Got it. There's no co-pay, no deductible.
[AGENT][NEUTRAL] Now, if you
[AGENT][NEUTRAL] No, this is because this is a supplemental policy to their primary insurance. So when the claim is submitted to APL, the salary, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have reviewed the claim and processed it with APL we do have a portal that you should be able to check claim status in by going to secured. [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK. Do you have a reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much have a good rest of your day.
[AGENT][POSITIVE] Well, you are very, yes ma'am, you too, that's all I can help you with, and thank you again, [PII] for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Um, bye bye.