AccountId: 011433970860
ContactId: 593838e8-8371-4ced-aa32-f1ddc3a8ccd5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245789 ms
Total Talk Time (AGENT): 130455 ms
Total Talk Time (CUSTOMER): 73835 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/593838e8-8371-4ced-aa32-f1ddc3a8ccd5_20250305T19:29_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good afternoon. I'm calling from a hospital to see a patient's benefits. You could help me out.
[AGENT][NEUTRAL] OK, you're only needing, yes, ma'am, you only need benefits. You do not also need eligibility.
[CUSTOMER][NEUTRAL] Um, an eligibility, both.
[AGENT][POSITIVE] Yes, ma'am. I can help you with both. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] My name is [PII] last name initial [PII]
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] Um, I, I'm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] The policy is 02.
[CUSTOMER][NEUTRAL] 45.
[CUSTOMER][NEUTRAL] 42
[CUSTOMER][NEUTRAL] 66.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] but any information that I 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] Mm
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that he is the subscriber on the supplemental policy. The supplemental policy is active Al with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] At an outpatient hospital.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum is per calendar day for covered outpatient services, and that benefit maximum is $750 and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK, so for, say, for instance, if he were to be having a surgery and he were to have an out of pocket max of 750, I'm just giving an an um.
[CUSTOMER][NEUTRAL] Uh, more or less it's not exactly those aren't his benefits, yeah.
[AGENT][NEUTRAL] Yeah, the, the maximum.
[AGENT][NEUTRAL] Yes ma'am. The maximum benefit on the supplemental policy is $750 per calendar day for covered outpatient services. Yes, ma'am. So when a claim is submitted to APL for review, we will also have to have a copy of his primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Oh, so he's having a er.
[CUSTOMER][NEUTRAL] Per day.
[CUSTOMER][POSITIVE] Oh OK perfect yeah.
[CUSTOMER][NEUTRAL] OK, so it's just 750 if it's an outpatient procedure, it's just the 11,750, right?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yes, ma'am. It's a 750 per calendar day benefit maximum.
[CUSTOMER][POSITIVE] Perfect. OK, and your name please?
[AGENT][NEUTRAL] Again, my name is [PII]. First initial to my last name is [PII]. My name and today's date would be your call reference number. And one last thing, [PII], once we have processed a claim here at APL, we do have a portal in which you should be able to check claim status, and our portal website is located at [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much for your help, [PII] and have a wonderful night. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome and can, oh well, I hope you do too if that's all that I can help you with. Thank you again for calling APL.
[CUSTOMER][POSITIVE] No problem thank you bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye bye.