AccountId: 011433970860
ContactId: 490db758-89d3-4896-b2be-c48422cf733d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 134300 ms
Total Talk Time (AGENT): 96001 ms
Total Talk Time (CUSTOMER): 25140 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=2.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/490db758-89d3-4896-b2be-c48422cf733d_20250428T16:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][POSITIVE] Hi, I'm calling to get outpatient benefits for a member.
[AGENT][POSITIVE] Yes, ma'am. I will be glad to help you. Go ahead and give me your uh name and the member's policy number, please.
[CUSTOMER][NEUTRAL] My name is [PII] and the policy number is 02509842.
[AGENT][NEUTRAL] Alright, [PII], thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty [PII], thank you for all that information. Now, your patient's name and date of birth today, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. Looks like he is the insured on this medical supplemental plan. I do show the original effective date as [PII]. Patient is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] Yes, outpatient.
[AGENT][NEUTRAL] OK. Outpatient at a hospital facility. What's patient having done?
[CUSTOMER][NEUTRAL] And the facility.
[AGENT][NEUTRAL] Facility, I mean.
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] All right, let me get that benefit pack pulled up. Now, of course, what we are is just the medical supplemental plan. So the only thing that we will pick up and pay on is anything for sickness and injury that is applied towards the deductible, co-pay, or co-insurance at the primary insurance carrier. We pay for nothing routine here no matter what the primary insurance carrier does.
[AGENT][NEUTRAL] Now the outpatient benefit here is a zero deductible, no pre-cert, and they have a maximum of $8700 payable per calendar year.
[CUSTOMER][POSITIVE] Alright, perfect.
[AGENT][POSITIVE] Yes, ma'am. Is that all I can help you with today?
[CUSTOMER][POSITIVE] Alright thank you so much for your help.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][POSITIVE] Yes. OK, [PII], thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You as well bye.
[AGENT][POSITIVE] Thank