AccountId: 011433970860
ContactId: 49a8a4fb-60f9-4021-bde6-6f91d50e4029
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204820 ms
Total Talk Time (AGENT): 106380 ms
Total Talk Time (CUSTOMER): 53428 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/49a8a4fb-60f9-4021-bde6-6f91d50e4029_20250123T14:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, um, hi [PII], um, I'm calling from West Boca Patient surgical Center. There's a patient that's here for surgery. I wanted to verify their benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Do you also need eligibility or do you already have that?
[CUSTOMER][NEUTRAL] Yes, I also need eligibility.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Um, [PII] is [PII] Last initial is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number please, Ms. [PII].
[CUSTOMER][NEUTRAL] Um, it's 01221549 ML 8.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] Just one second, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, 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] Um, [PII], um, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that he is the subscriber on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And you did say that you were the outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and how much, yes, and how much do we cover up to?
[AGENT][NEUTRAL] OK, the outpatient benefit maximum for covered outpatient services on this supplemental policy is $4000 per calendar year per covered person, and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and
[AGENT][NEUTRAL] Now when the mhm.
[CUSTOMER][NEUTRAL] OK, and is there a reference for this call?
[AGENT][NEUTRAL] There is you would use my name that I gave you along with today's date and then just a couple of additional pieces of information, [PII], we will also have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And once we have processed our claim, we do have a portal in which you should be able to check claim status and have access to our EOB and that portal website for the is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and can you, um, remind me of your name and the last initial?
[AGENT][NEUTRAL] My name is [PII] and the first initial to the last name is [PII]
[CUSTOMER][POSITIVE] Uh, thank, thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] Yes, ma'am. I hope you do too, Ms. [PII] and thank you again for calling APL.
[CUSTOMER][NEUTRAL] You too now bye bye.
[AGENT][NEUTRAL] Um, bye-bye.