AccountId: 011433970860
ContactId: 57d715fa-745b-461a-b4b8-69aac664f65f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204399 ms
Total Talk Time (AGENT): 104595 ms
Total Talk Time (CUSTOMER): 59161 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/57d715fa-745b-461a-b4b8-69aac664f65f_20250205T19:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to verify um benefits for the supplement plan, please.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify outpatient benefits for a member. Is that correct?
[CUSTOMER][POSITIVE] Correct. Correct, outpatient. Mhm.
[AGENT][NEUTRAL] Yes, so I, uh-huh, I can help you with that. Do you also need eligibility?
[CUSTOMER][NEUTRAL] Uh, yes, just to confirm the patient's active for the month, please.
[AGENT][POSITIVE] OK, yes, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes, it's um [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, it is. Give me one moment, let me see here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so 02441932 ML 7.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[AGENT][NEUTRAL] And any information that I do provide for you, [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] It's [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do see she is the spouse of the subscriber on this supplemental policy, and this supplemental policy, [PII] is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And she has an outpatient benefit maximum of $500 per covered person per calendar day for covered outpatient services with no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, to 500 per day, OK.
[AGENT][NEUTRAL] Mhm. And because this is a supplemental policy to her primary insurance, we will also have to have a copy of her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][POSITIVE] Alrighty then got it so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal that you should be able to check claim status in and have access to our EOB and that portal website Scarlett is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, perfect. So it's a 500 per day. OK, um, alright, in that case actually all the information I needed the patient is active and it's 500 per day. Um, if I can please have a reference number for the call.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Got it thank you for your help, [PII] have a great rest of your day.
[AGENT][POSITIVE] Well, you are certainly, yes ma'am, I hope you do too, and thank you again [PII] for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome.