AccountId: 011433970860
ContactId: 44df6f9a-590c-496b-8030-7704bcaf565c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291299 ms
Total Talk Time (AGENT): 164556 ms
Total Talk Time (CUSTOMER): 86641 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/44df6f9a-590c-496b-8030-7704bcaf565c_20250425T14:24_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, my name is [PII]. We're the provider. Um, can you please help me with, uh, let's see here, yes, patient, uh, eligibility and benefits.
[AGENT][NEUTRAL] OK, [PII], so you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Mhm. Yes, [PII].
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. I can help you. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is the member's policy number, please?
[CUSTOMER][NEUTRAL] OK, 02610047.
[AGENT][NEUTRAL] OK, thank you. One moment, [PII], um, for me to get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] and her last name is [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on the supplemental policy, [PII], and this supplemental policy is active with an effective date of [PII].
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, it's for outpatient. She came in for like express care visit. So do you want me to explain what the Express Care is?
[AGENT][NEUTRAL] No, ma'am, you don't need to do that. So for her outpatient outpatient benefit maximum per calendar year for covered outpatient services is $5500 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because this is a supplement.
[CUSTOMER][NEUTRAL] OK, so she does have that.
[CUSTOMER][NEUTRAL] OK, so she does, she does have that extra coverage?
[AGENT][NEGATIVE] She does, and as of now, we do not have any history on file for her there and she has not used any benefits as of now.
[CUSTOMER][NEUTRAL] OK, you said she's the spouse on the plan?
[AGENT][POSITIVE] Uh-huh. That is correct.
[CUSTOMER][NEUTRAL] OK, so she, so let me put the plan.
[CUSTOMER][NEUTRAL] American Public.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because it is a supplement to their primary insurance, [PII], when the claim is submitted to APL for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then once we have processed our claim here, we do have a portal that you should be able to check our claim status in and the website for our portal is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, thank you. What is the group name gonna be?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Group name is, I'll just spell it for you. It's N A V A L I M P I A N T I.
[AGENT][NEUTRAL] USA Inc all one word.
[CUSTOMER][NEUTRAL] That's all one word?
[CUSTOMER][NEUTRAL] So, OK, OK, N A.
[AGENT][NEUTRAL] Naval and Ponte.
[AGENT][NEUTRAL] Naval andante.
[CUSTOMER][NEUTRAL] OK, oh, I spelled it wrong. OK, Nava, N A V A.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] L
[AGENT][NEUTRAL] I am P as in Peter.
[AGENT][NEUTRAL] I A N T I.
[AGENT][NEUTRAL] Then separately, it's.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh, then USA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Inc.
[CUSTOMER][NEUTRAL] INC, OK, what is the group number gonna be?
[AGENT][NEUTRAL] 20, I'm sorry, 27008.
[CUSTOMER][POSITIVE] 008 OK perfect 27008. OK perfect.
[AGENT][NEUTRAL] The Naval Iante USA Inc 27008.
[CUSTOMER][NEUTRAL] Oh, OK, hold on, let me give a call right back. Let me give a call right back.