AccountId: 011433970860
ContactId: 4413706b-68cc-4c86-9790-56d211080671
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243399 ms
Total Talk Time (AGENT): 145505 ms
Total Talk Time (CUSTOMER): 56819 ms
Interruptions: 1
Overall Sentiment: AGENT=2.3, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/4413706b-68cc-4c86-9790-56d211080671_20250619T16:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to verify benefits and eligibility.
[AGENT][NEUTRAL] OK, you have eligibility and benefits that you're needing to verify, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And who am I speaking with, please? You're welcome.
[CUSTOMER][POSITIVE] Thank you, my name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And um do you just have one member that you're needing to verify eligibility and benefits for? OK. What is that patient's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's 02517200 ML 8.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] And the information [PII] 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] I
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] Office please.
[AGENT][NEUTRAL] OK, moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this policy does not provide benefits for office visits.
[AGENT][NEUTRAL] If she were to receive some form of treatment in the office, she does have a treatment writer in which we could review benefits for the treatment itself, but not for the visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So would you like her outpatient benefit maximum? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum it per calendar day for covered outpatient services is $750 and there is no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] Because it is a
[CUSTOMER][NEUTRAL] So they cover up to 750 per day.
[AGENT][NEUTRAL] Uh-huh, for covered outpatient services, yes, ma'am. And because it is a supplemental policy to her primary insurance, we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] And then once we have processed our claim here we have a portal that you should be able to check claim status in Carla and the website for that is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is registration required?
[AGENT][NEUTRAL] Yes ma'am, it's a self registering portal.
[AGENT][NEUTRAL] And that will be for once the claim has been processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK all right perfect well thank you so much and is there a reference number for this call?
[AGENT][NEUTRAL] I was.
[AGENT][POSITIVE] Yes, ma'am, you're actually gonna use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] All right. Well, you're very welcome. So is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Uh no, that was it thank you.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you for calling APL. I hope you have a great afternoon.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you.