AccountId: 011433970860
ContactId: 4cb73838-ff9a-4bfb-adab-166fd1c83222
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195220 ms
Total Talk Time (AGENT): 105277 ms
Total Talk Time (CUSTOMER): 40061 ms
Interruptions: 0
Overall Sentiment: AGENT=2.3, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/4cb73838-ff9a-4bfb-adab-166fd1c83222_20250523T12:59_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] I see that
[CUSTOMER][NEUTRAL] Hi, yes, good morning. I'm calling from Nicholas Children's Ambulatory Surgery Center. I'm calling for a patient's eligibility and benefits.
[AGENT][NEUTRAL] OK, yes ma'am, you're needing outpatient eligibility and benefits for members, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] It's going to be [PII]
[AGENT][NEUTRAL] Thank you. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, it's going to be 01845832ML8.
[AGENT][POSITIVE] OK, thank you [PII]. One moment please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that she is a dependent on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And again [PII], you did say that you were needing outpatient benefit information, is that correct?
[CUSTOMER][POSITIVE] Hm correct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Set the outpatient benefit max per calendar year for covered outpatient services per covered person is $1000.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] For calendar year, yes ma'am, and because this is a pri supplement to the primary insurance, when the claim is submitted to APO for review, we will also have to receive a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we process our claim here at APL we do have a portal that you all should be able to check claim status in [PII]. The website for that is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And is there anything else that I could help you with this morning?
[CUSTOMER][POSITIVE] No, you've been very helpful.
[AGENT][POSITIVE] Oh, well, it was my pleasure speaking to you today, [PII], and thank you again for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Of course you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye.