AccountId: 011433970860
ContactId: 60e37e85-adca-4e07-a080-3a007896a151
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249300 ms
Total Talk Time (AGENT): 128570 ms
Total Talk Time (CUSTOMER): 60899 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/60e37e85-adca-4e07-a080-3a007896a151_20250124T17:44_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] Good afternoon, [PII]. My name is [PII] and I'm calling to get benefits for mutual patient.
[AGENT][NEUTRAL] OK. And you said your name is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct, correct.
[AGENT][NEUTRAL] Yes, I can help you with that. And do you also need excuse me, eligibility [PII] or just benefits?
[CUSTOMER][NEUTRAL] Uh, just actually eligibility and benefits, please.
[AGENT][POSITIVE] Yes, I can help you with both and what is your callback number, please?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] The policy number is 02295813 M as in Mike, L as in Larry 8.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK give me just one second and I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information on that 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] The patient's name is [PII], which is [PII]
[CUSTOMER][NEUTRAL] [PII] with a date of birth of [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that she is the spouse of the subscriber on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient diagnostic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year per covered person for covered outpatient services and another that is $3500 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a, uh, and because this is a supplemental policy to their primary insurance, we will also have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Along with the claim for review and then once we have processed our claim we do have a portal in which you should be able to check claim status.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the portal website for APL is secured. [PII].
[CUSTOMER][NEUTRAL] I like
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Got it. And [PII] I ask for the 3500, is there, are there any accumulations on that?
[AGENT][NEUTRAL] I can check one moment, and this is for an upcoming service you're referring for this calendar year?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEGATIVE] As of now, there have not been any benefits used.
[CUSTOMER][NEUTRAL] OK perfect thank you for the information, [PII] and may I please get a reference number?
[AGENT][NEUTRAL] As of this moment.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And you would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you for your help. You have a great day.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL. I hope you have a great weekend also.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh, bye bye.