AccountId: 011433970860
ContactId: 52dee135-8a62-46d6-a259-36b3883ae11e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 206580 ms
Total Talk Time (AGENT): 120709 ms
Total Talk Time (CUSTOMER): 34933 ms
Interruptions: 1
Overall Sentiment: AGENT=2.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/52dee135-8a62-46d6-a259-36b3883ae11e_20250624T12:11_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, um, my name is [PII]. I was calling to get out patient benefits for patients.
[AGENT][NEUTRAL] OK, [PII], you're needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you also need eligibility, [PII], or just outpatient benefits?
[CUSTOMER][NEUTRAL] Well yeah, we always have to check, you know, if it's active, if it's an active policy.
[AGENT][NEUTRAL] OK, so you need eligibility and benefits, is that correct?
[CUSTOMER][POSITIVE] Correct. Mhm mhm.
[AGENT][POSITIVE] Yes, ma'am, I can help you with both. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] 02219127
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] Yeah.
[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 their date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber, I'm sorry, she is the spouse of the subscriber on the supplemental policy, [PII], and you're saying the policy is active with an effective date of [PII]. And give me one moment to get her in, I'm sorry, out. I can't talk this morning, [PII]. Her outpatient benefits, just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the outpatient benefit maximum per calendar day for covered outpatient services is $500 per covered insured and there is no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] Now because this is a supplemental policy to the primary insurance, we will have to have a copy also of her primary insurance company's explanation of benefits along with the claim. And then once we have processed our claim here at APL, we do have a portal that you all should be able to check claim status in, and the website for our portal is located at secured.
[CUSTOMER][NEUTRAL] OK yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Alright, [PII], thank you so much for your help. I hope you have a wonderful day, OK.
[AGENT][POSITIVE] Well, you're welcome. Yeah, yes, ma'am. I hope you have a wonderful day too. Is that all I can help you with this morning, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Thank you. Bye bye.