AccountId: 011433970860
ContactId: 43e9b711-2a69-4790-af5f-52b883cccac5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289559 ms
Total Talk Time (AGENT): 147380 ms
Total Talk Time (CUSTOMER): 52739 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=3.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/43e9b711-2a69-4790-af5f-52b883cccac5_20250227T21:38_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, good afternoon, [PII]. My name is [PII], last initial [PII]. I was calling to get outpatient benefits for a patient.
[AGENT][NEUTRAL] OK [PII], you're needing outpatient benefits, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] Yes ma'am, I can help you with that. And do you also need eligibility or do you already have that?
[CUSTOMER][NEUTRAL] Um, no, I already have that. I just need the outpatient benefits, yeah.
[AGENT][POSITIVE] Sure, yes, I can help you and what is your callback number please [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 1482197ML8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. So the policy number, she is the subscriber, however, the policy number you gave me is an old policy number that's no longer active.
[AGENT][NEUTRAL] It actually turned [PII].
[AGENT][NEUTRAL] There is another policy that is active with a different number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, will we be able to get that?
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] Mhm, so the correct policy number that you should have is 02464411.
[AGENT][NEUTRAL] And this policy again is active with an effective date of [PII].
[AGENT][NEUTRAL] And give me a moment and I like to get that information pulled up, please.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] I appreciate it.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and again you just need outpatient benefits, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max of $4000 per covered person per calendar year for covered outpatient services with no deductible.
[CUSTOMER][POSITIVE] Perfect. And has she used any of that 4000?
[AGENT][NEUTRAL] I can check, one moment.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] And you are referring for this calendar year, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] As of now she has used $432.64.
[CUSTOMER][POSITIVE] Perfect. OK, uh thank you so much for your help. Yeah.
[AGENT][NEUTRAL] And then
[AGENT][POSITIVE] Yes ma'am, just a couple of more things um for you [PII].
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Because this is a supplement to her primary insurance, we will have to have a copy of her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then lastly once we have processed our claim.
[AGENT][NEUTRAL] We do have a portal that you all should be able to check our claim status and have access to our EOBs.
[AGENT][NEUTRAL] And that portal website is located at [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Well, you're certainly very welcome and is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, can I just have a reference number for the call, please?
[AGENT][NEUTRAL] Yes, ma'am. You would use my name along with today's date and then you need the first initial to my last name, it's [PII].
[CUSTOMER][POSITIVE] Perfect, thank you again.
[AGENT][POSITIVE] OK, well, you're welcome, [PII] and thank you for calling APL. I hope you have a nice evening.
[CUSTOMER][NEUTRAL] E
[AGENT][POSITIVE] Thank you. Bye-bye.