AccountId: 011433970860
ContactId: 64801c39-1e2c-4ae9-a474-8ee778b25eba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293260 ms
Total Talk Time (AGENT): 144166 ms
Total Talk Time (CUSTOMER): 115808 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/64801c39-1e2c-4ae9-a474-8ee778b25eba_20250217T18:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. This is [PII] speaking, and I'm calling from Mount Sinai Medical Center. The reason of this call today is just to confirm benefits eligibility. You said your name was [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm sorry, what was
[AGENT][NEUTRAL] No, my name is [PII]
[AGENT][NEUTRAL] And what was your name? Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII], which is [PII].
[AGENT][NEUTRAL] I'm sorry, what was the last letter?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] There is, uh, we don't have a very good connection. You sound very far away from the phone, so I'm having trouble understanding you. Can you spell your name again?
[CUSTOMER][NEUTRAL] OK, can you hear me better now?
[AGENT][NEGATIVE] Yeah, if there's just an echo on this call again it sounds like you're on a speaker phone, not I, I don't know, it's not a good connection.
[CUSTOMER][NEUTRAL] OK. I really, yes, I understand and um unfortunately, my headsets are not currently working, so this is the only thing I have. So, can you hear me better now?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's a little better, that's a little better, yes. So, could you spell your name again for me, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] The last name is [PII].
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes, uh-huh, yes, ma'am.
[AGENT][NEUTRAL] OK, [PII]. Thank you. And your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And you said that you were needing benefits and eligibility for a member, is that correct, [PII]?
[CUSTOMER][POSITIVE] That is correct. Mhm.
[AGENT][NEUTRAL] Yes, ma'am, I can help you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Let me just give you the member ID, so it's 53147.
[CUSTOMER][NEUTRAL] 636.
[CUSTOMER][NEUTRAL] 3 and then there's 3 consecutive viewings, OK?
[AGENT][NEUTRAL] OK, now that is not a policy number for our company. I'm with American Public Life Insurance.
[CUSTOMER][NEUTRAL] I, yes, you are you are completely right. That's the first policy that we have on file. So this is the one, so it's 02343220, M as in Mary, L as in Lily, 8.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] And only, 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 and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] The first name is [PII]. Last name is [PII]. Date of birth is on [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I do show that she is the subscriber on the supplemental policy, No, and the policy is active with an effective date of [PII], and this is a supplemental policy to her primary insurance. So what type of benefit information are you needing inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] This is gonna be at an outpatient facility?
[CUSTOMER][NEUTRAL] This is gonna be as an outpatient facility. She is coming for an excuse me.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] She's going for an ultrasound of the breast and also for a diagnostic mammogram, OK?
[AGENT][NEUTRAL] So her outpatient benefit maximum for covered outpatient services is $7350 per calendar year.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And because this is a supplemental policy to her primary insurance, we must also receive a copy of her primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed the claim here at APL, we do have a portal that you should be able to check claim status and also have access to our explanation of benefits.
[CUSTOMER][POSITIVE] OK, sounds good. Thank you so much for that help. Could I please also get a uh reference number for this?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Thank you so much and I hope you have a great day.
[AGENT][POSITIVE] I hope you do too. Thank you very much for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Bye-bye.