AccountId: 011433970860
ContactId: 67020b31-6a5b-4dd1-867b-d6f3a47743a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409679 ms
Total Talk Time (AGENT): 195296 ms
Total Talk Time (CUSTOMER): 106251 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/67020b31-6a5b-4dd1-867b-d6f3a47743a7_20250521T13:52_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 morning. My name is [PII]. I am just calling to get benefits for a patient. She's coming into the hospital.
[AGENT][NEUTRAL] OK, [PII], so you're needing eligibility or eligibility and benefits, both?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, both.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] It is, sorry, it's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] OK, that's our electronic payer ID. That is not the member's policy number, [PII].
[CUSTOMER][NEUTRAL] Mmm.
[CUSTOMER][NEUTRAL] OK, I'm gonna have to
[CUSTOMER][POSITIVE] Double check with her. OK, I'm so sorry about that. That is what she gave me.
[AGENT][NEUTRAL] OK. Do you have any, uh, do you have a cop, so you don't have a copy of her card?
[CUSTOMER][NEUTRAL] No, not on file.
[AGENT][NEUTRAL] OK, do you happen to have the full social?
[CUSTOMER][NEUTRAL] Let me just double check here.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] No, she did not want to provide that. OK.
[AGENT][NEUTRAL] OK. Did she give you a group number?
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I have group number 16094.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what is the patient's name and date of birth? Or, well, first off, just the name. What's the patient's name?
[CUSTOMER][NEUTRAL] [PII] or [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII], I believe I may have located a policy for this number and any information again that I do provide will be a verification of benefits and not a guarantee of payment. So just one moment.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so if you could please verify her name again and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, on her last name, we also have it as [PII] hello.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh let me see, let me double check here.
[CUSTOMER][NEUTRAL] OK, so on her insurance and on her file here she only has them.
[CUSTOMER][NEUTRAL] The.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the correct policy number that you should have for this supplemental coverage is 0257.
[AGENT][NEUTRAL] 63, I'm sorry, let me start over.
[AGENT][NEUTRAL] 025767
[AGENT][NEUTRAL] 35.
[AGENT][NEUTRAL] And this policy is active, you're welcome. This policy is active, effective [PII].
[CUSTOMER][POSITIVE] Awesome, thank you so much for that.
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient or outpatient or office?
[CUSTOMER][NEUTRAL] Um, outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy her outpatient benefit maximum per calendar year for covered outpatient services is $7150 and there is a $250 outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Has she used any of the 7150?
[AGENT][NEUTRAL] No. As of now, she has not met her deductible or used any of her benefits.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Well, that's so much better than what the hospital's charging her, so that's awesome.
[AGENT][NEUTRAL] And then um also because this is a supplemental policy, [PII] to her primary health care insurance, when the claim is submitted to APL for review, we will also have to have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim, OK, and after we have processed the claim here at APO we do have a portal that you should be able to check claim status in.
[CUSTOMER][POSITIVE] OK, yeah, she'll definitely get that.
[AGENT][NEUTRAL] And the website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. I'll give her that.
[AGENT][NEUTRAL] OK, so she will be filing the claim you all do not file the claims?
[CUSTOMER][NEUTRAL] Um, we put it in our systems and then, um, I believe that she'll file the claim with the supplemental, yes.
[AGENT][NEUTRAL] OK, so she will have to have an itemized bill.
[AGENT][NEUTRAL] RUBO4 to submit to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you all are not gonna be filing it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She will need to get that from you all.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty, perfect. Thank you so much.
[AGENT][POSITIVE] Well, you are very welcome. And is there anything else that I could help you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you so much, Ms. [PII]. You've been wonderful.
[AGENT][POSITIVE] Well, oh, well I, well, it was my pleasure in helping you today, [PII], and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too. Bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye.