AccountId: 011433970860
ContactId: 560aa2c5-d331-4da0-b82c-ca7c4c2f6d0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299200 ms
Total Talk Time (AGENT): 128186 ms
Total Talk Time (CUSTOMER): 72190 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/560aa2c5-d331-4da0-b82c-ca7c4c2f6d0f_20250609T18:52_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], last initial [PII], and I was calling to gather benefits for an outpatient procedure.
[AGENT][NEUTRAL] OK, [PII], you're needing only benefits or do you also need eligibility?
[CUSTOMER][NEUTRAL] Eligibility as well please.
[AGENT][NEUTRAL] OK, so you're needing eligibility and outpatient benefits, is that correct for a member?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Uh yes, ma'am, I can help you with that. And [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It is 022.
[CUSTOMER][NEUTRAL] 03776
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And any information that I did provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so again, any information provided will be a verification of benefits and not a guarantee of payment. So I do show that she is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And on this plan, the outpatient benefit max.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She has an outpatient benefit max for combined inpatient and outpatient of $1500 per calendar year for covered services with no deductible.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] And because this is a supplement to her primary insurance when the claim is submitted to APL for review, we must also receive a copy of the.
[AGENT][NEUTRAL] Primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well, and then we do have our portal, [PII] that once we have processed the claim here at APL you should be able to check claim status by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Alright, and then on that out of pocket max has she met any amount towards that out of pocket?
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] I can check that for you one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] And no, ma'am, for this calendar year, she has not used any benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and then just to clarify once that out of pocket max is reached, would the patient be responsible for any of their primary charges?
[AGENT][NEUTRAL] We do not determine patient responsibility. That would be up to the provider, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][POSITIVE] Alright, perfect then I should make that and if I could just get a reference number please.
[AGENT][NEUTRAL] Sure, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] All right thank you hope you have a great rest of your day.
[AGENT][POSITIVE] Well, oh, I hope you have a great rest of your day too. It's my pleasure in speaking with you and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] All right, [PII], bye-bye.