AccountId: 011433970860
ContactId: 5404e5b1-3ee5-4bd8-acf0-bf3ae9a4510f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263929 ms
Total Talk Time (AGENT): 141210 ms
Total Talk Time (CUSTOMER): 60149 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/5404e5b1-3ee5-4bd8-acf0-bf3ae9a4510f_20250407T13:56_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 Ms. [PII], my name is [PII]. I'm calling from Spartanburg Medical Center. How are you?
[AGENT][POSITIVE] I'm good, [PII]. How are you doing today?
[CUSTOMER][NEUTRAL] I'm OK thank you um I have a I have a patient I want to see if I can obtain benefits for, well, I don't, I'm trying to see if she has benefits for outpatient speech therapy or if it's just like hospital or accident related.
[AGENT][POSITIVE] Good. Well, how can I help you?
[AGENT][NEUTRAL] OK, so you're needing to see if there are benefits for speech therapy. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII] and that's direct.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02545422
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] Do you also need eligibility for the member, [PII] or strictly benefits? OK.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, and [PII], any information I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that Ms. [PII] is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And she does have benefits on this supplemental policy for speech therapy. She has an outpatient benefit maximum on this plan for covered outpatient services of $1000 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then there is no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] Now, because this is a supplement, [PII] to her primary insurance, when the claim is submitted to APL for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have, excuse me, then once we have processed our claim here, we do have a portal in which you should be able to check our claim status and our portal website [PII] is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there any other information that I can help you with this morning?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Uh, do you require authorization?
[AGENT][NEUTRAL] Uh, no, ma'am. There is no prior authorization required since this is a supplemental policy.
[CUSTOMER][POSITIVE] OK, alright, thank you so much I appreciate your help um what is the.
[AGENT][POSITIVE] All right. Well, you are certainly very welcome.
[CUSTOMER][NEUTRAL] What's the first initial to your last name?
[AGENT][NEUTRAL] [PII], and again, my name in today's date will be your call reference number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right sounds good you have a good rest of your day and week.
[AGENT][POSITIVE] All right. Well, thank you so much. I hope the same things for you too, [PII], and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.