AccountId: 011433970860
ContactId: 66755487-a29a-41c0-a2d4-15322a4b00ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344329 ms
Total Talk Time (AGENT): 162370 ms
Total Talk Time (CUSTOMER): 95566 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=2.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/66755487-a29a-41c0-a2d4-15322a4b00ba_20250106T18:54_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] Hi, good afternoon, Ms. [PII]. My name is [PII] and I'm calling from Baptist Outpatient. I'm calling to check the benefits for patient, please.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, you're needing to check benefit information, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes, Ms. [PII].
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] The policy number 02419387 M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your excuse me, your patient's name and date of birth please, [PII]?
[CUSTOMER][NEUTRAL] Yes. Patient name is [PII]. Last name, give me one second. It's really long. Uh, [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII] is her last name.
[AGENT][POSITIVE] OK, thank you. OK.
[AGENT][NEUTRAL] OK, thank you. So, um, is this for a future data service?
[AGENT][NEUTRAL] That you're needing information, this policy is no longer active.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] It's no longer active.
[AGENT][NEUTRAL] This policy was correct, this policy was active from [PII]. There is another policy that is active, but what I'm needing to know is do you need benefit information for the policy that's currently active or for this policy?
[CUSTOMER][NEUTRAL] It's for the one currently active, please.
[AGENT][NEUTRAL] OK, so just one moment while I get that information pulled up.
[CUSTOMER][POSITIVE] Thank you. For outpatient facility, please.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the current active policy number [PII].
[AGENT][NEUTRAL] Is 255.
[AGENT][NEUTRAL] 649-0.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] And you said the number is 2,556,490?
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][NEUTRAL] And you again it is outpatient benefits that you're needing?
[CUSTOMER][NEUTRAL] Correct, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the outpatient benefit maximum per calendar year for covered outpatient services is $8700 for covered insured.
[AGENT][NEUTRAL] And there is
[CUSTOMER][NEUTRAL] You said 8700. I'm sorry, Ms. [PII].
[AGENT][POSITIVE] Yes. Yes, ma'am. That is correct.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][POSITIVE] Perfect, Ms. [PII]. And has the patient used any anything from, from the 8700 or it's still the same?
[AGENT][NEUTRAL] As in
[AGENT][NEUTRAL] As of now, for this beginning for this calendar year?
[AGENT][NEUTRAL] Let me check.
[AGENT][POSITIVE] As of now, we have not received any claims.
[CUSTOMER][NEUTRAL] Remaining, let's see.
[AGENT][NEUTRAL] As of now.
[CUSTOMER][POSITIVE] Perfect, Ms. [PII]. Ms. [PII], can I have the nature of your last name and your time zone, please?
[AGENT][NEUTRAL] Yes, it's
[AGENT][NEUTRAL] It's my first initial to my last name is [PII], and my name and today's date will be your call reference number and I'm on Central time.
[AGENT][NEUTRAL] And then [PII], we do have our portal for claim status to be checked and that is secured. [PII].
[CUSTOMER][POSITIVE] Perfect. So.
[AGENT][NEUTRAL] And then I'll say when the claim is submitted to APL for review, we must also have a copy of her primary insurance company's explanation of benefits as well for review.
[CUSTOMER][POSITIVE] Perfect, Ms. [PII].
[AGENT][NEUTRAL] Along with the claim. All right. Well, can I help you with anything else today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that was all. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL and I hope that you have a great afternoon.
[CUSTOMER][NEUTRAL] Likewise. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.