AccountId: 011433970860
ContactId: 603d7952-2d21-46ac-8735-9d9b9c48489e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250779 ms
Total Talk Time (AGENT): 135253 ms
Total Talk Time (CUSTOMER): 61087 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=2.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/603d7952-2d21-46ac-8735-9d9b9c48489e_20250620T14:12_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], last initial [PII] I'm calling to verify benefits in the check, um, or just to verify benefits for outpatient surgery for a patient.
[AGENT][NEUTRAL] OK, [PII], so you're only needing benefits. You do not need eligibility, is that correct?
[CUSTOMER][NEUTRAL] Um, we can go over eligibility as well.
[AGENT][POSITIVE] OK, yes ma'am. I can help you with both things. And what is your callback number, please?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] It's [PII] option one.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] It's 02255658 ML 8.
[AGENT][NEUTRAL] Thank you. One moment please while I get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], any information 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, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And for your information in our records, it's.
[AGENT][NEUTRAL] [PII] and he is the subscriber mhm and that supplemental policy again it is active effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient and it's going to be done at a freestanding facility, so an ambulatory surgical center, non-hospital based outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, one moment, please.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $1000 for covered again for covered outpatient services and then there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy, [PII] to his primary insurance when the claim is submitted to us for review, we will also have to have a copy of his primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here we do have a portal that you should be able to check claim status in and the website for our portal is located at secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Am public.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] Yes ma'am, you're very welcome and is there anything else that I could help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yes, can you go over if there's any accumulations on the $1000?
[AGENT][NEGATIVE] As of now, there have not been any benefits used as of this moment.
[CUSTOMER][POSITIVE] Perfect. So just, OK, so it would just be $1000 for outpatient, um, yearly or calendar year, correct?
[AGENT][POSITIVE] Per calendar year, yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] Thank you, may I please have a reference number for today's call?
[AGENT][NEUTRAL] Yes ma'am, you would use my name that I gave you along with today's date and the first initial to my last name if you need that is [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much I hope you have a wonderful day.
[AGENT][POSITIVE] I hope you do too, [PII], and thank you again for calling APL.
[CUSTOMER][POSITIVE] You thank you bye bye.
[AGENT][NEUTRAL] Uh-huh, bye.