AccountId: 011433970860
ContactId: 57ff09df-7c17-4f21-8231-064e03551881
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269179 ms
Total Talk Time (AGENT): 117912 ms
Total Talk Time (CUSTOMER): 59845 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/57ff09df-7c17-4f21-8231-064e03551881_20250429T12:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I was calling to get outpatient benefits for a patient.
[AGENT][NEUTRAL] OK, [PII], are you only needing outpatient benefits or do you also need eligibility as well?
[CUSTOMER][NEUTRAL] Well, yeah, so obviously check it I mean like if she's active as well.
[AGENT][POSITIVE] Yes, I can help you with both, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] It's 02608027.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, and any information [PII] that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the subscriber on the supplemental policy. It is active.
[AGENT][NEUTRAL] And the effective date is [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one moment please, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum for accident and sickness of $5000 per covered person per calendar year for covered outpatient services, and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy to her primary insurance, if a claim is submitted to us for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal that you should be able to check claim status in and that portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm, I work in the insurance certification department, but thank you, yeah, because I don't, I don't process claims, yeah.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] OK. I didn't know if there was a way you could make a note because that will be required when reviewing your claim.
[CUSTOMER][POSITIVE] I've been in the apartment, yeah, yeah, we've been, well, at least I've been already in [PII] for like 6 years and we've been seeing this, like getting this plan like a lot ever like all these years, so I'm pretty sure they would like, you know, they already got access, but thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And then uh for the reference number uh [PII] I just used like your name and today's data.
[AGENT][NEUTRAL] My name and today's date will be your call reference number.
[CUSTOMER][POSITIVE] Perfect. I really appreciate it. I hope you have a wonderful day, OK?
[AGENT][POSITIVE] All right. Well, you're welcome. Yes, ma'am, you too. So again, if that's all I can help you with, thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. Bye-bye.