AccountId: 011433970860
ContactId: 6004c1a4-e292-4bdd-8dbd-244e09710758
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249899 ms
Total Talk Time (AGENT): 133172 ms
Total Talk Time (CUSTOMER): 57651 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/6004c1a4-e292-4bdd-8dbd-244e09710758_20250108T17:42_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, yes, my name is [PII]. Last initial [PII]. I'm calling from a provider's office to verify benefits for patients.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct? And you're needing to verify benefits for a member?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you also need to verify eligibility, [PII]?
[CUSTOMER][POSITIVE] Uh yes please.
[AGENT][POSITIVE] Yes, I can help you with both of those things. And first off, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number.
[CUSTOMER][NEUTRAL] Yes, it is 01812665 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] no
[AGENT][NEUTRAL] And [PII], any information that I do 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] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It is uh [PII]. Uh, date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that she is the subscriber on the supplemental policy and it is active with an effective date of [PII]. And what type of benefit information are you needing for her inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] I just uh checking to see if she has um benefits for outpatient surgery.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] It'll be ambulatory center but outpatient.
[AGENT][NEUTRAL] OK, sure, one moment.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum of $1000 per covered person per calendar year for covered outpatient services, and there is no outpatient deductible for covered person per calendar year.
[CUSTOMER][NEUTRAL] So you said 1000?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][POSITIVE] Perfect and how much has she used of that?
[AGENT][NEUTRAL] For this calendar year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] As of now for [PII], there have not been any benefits used.
[CUSTOMER][NEUTRAL] OK perfect can I get a reference number for the call please?
[AGENT][NEUTRAL] Um, and yes, ma'am, and just a couple of other things first, [PII], because this is a supplement to our primary insurance, we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review. And then once we have processed the claim, we do have a portal that you can check claim status and have access to our explanation of benefits.
[AGENT][NEUTRAL] And that portal website is [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And the um reference number for our call today will be my name along with today's date.
[CUSTOMER][NEUTRAL] OK, what was your name again?
[AGENT][NEUTRAL] [PII] first initial S.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][NEUTRAL] The last name.
[AGENT][POSITIVE] You are very welcome. So is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that'll be all thank you.
[AGENT][POSITIVE] OK, well then, thank you for calling APO Valer and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.