AccountId: 011433970860
ContactId: 4a5ba4be-ae7d-46b1-9b86-9110fdc13d87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238839 ms
Total Talk Time (AGENT): 126708 ms
Total Talk Time (CUSTOMER): 59687 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=2.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/4a5ba4be-ae7d-46b1-9b86-9110fdc13d87_20250210T15:19_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, good morning, [PII]. Uh, my name is [PII]. I'm calling from Doctor's Hospital. I just wanted to check on, um, benefits for a patient's upcoming appointment.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with um benefits. Is that correct, benefits and eligibility?
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][NEUTRAL] OK, uh, what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] That will be [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] It's 02118985, M as in Mary, L as in Larry, 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information that I do provide for you today 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 date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the subscriber on the supplemental policy, [PII], and the supplemental policy is active. What's an effective date of [PII]?
[AGENT][NEUTRAL] And again you what type of benefits are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, outpatient, uh, for physical therapy.
[AGENT][NEUTRAL] OK, so she does, um, on her outpatient benefits.
[AGENT][NEUTRAL] And is this gonna be done at a physical therapy facility?
[CUSTOMER][NEUTRAL] Uh, no, it's gonna be done at our outpatient hospital, um, facility.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] So she has an outpatient benefit max.
[AGENT][NEUTRAL] Her calendar day for covered outpatient services of $500.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar day.
[CUSTOMER][POSITIVE] Perfect. All right. Thank you so much.
[AGENT][NEUTRAL] And because this is a supplement absolutely and because this is a supplemental policy to her primary insurance when the claim is submitted to APL for review, we must also receive a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Supplement.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal in which you can, you should be able to check claim status and also have access to our explanation of benefits.
[AGENT][NEUTRAL] And our portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. OK. And is there any way to get a reference number for this call?
[AGENT][POSITIVE] Yes ma'am, you're gonna use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much for your help.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that's all thing that I can help you with, thank you again for calling APL level and, and I hope you have a very nice day also.
[CUSTOMER][POSITIVE] You as well. Take care.