AccountId: 011433970860
ContactId: 6ab59c39-185a-44f3-a14b-7e1bb8fe9681
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262179 ms
Total Talk Time (AGENT): 135547 ms
Total Talk Time (CUSTOMER): 60452 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/6ab59c39-185a-44f3-a14b-7e1bb8fe9681_20250416T19:17_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi how are you?
[AGENT][POSITIVE] I'm good, and yourself?
[CUSTOMER][POSITIVE] Good good um I am calling to get benefits and eligibility from I'm calling to get benefits and eligibility for a member please.
[AGENT][POSITIVE] Good, how can I help you?
[AGENT][NEUTRAL] OK, yes ma'am, you're needing benefits and eligibility for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, it is 0 02497482.
[CUSTOMER][NEUTRAL] Sorry Toya.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK [PII], thank you one moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any the information provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The name is [PII] and the date of birth is um [PII], sorry.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that, OK, so first off, any information provided would be a verification of benefits and not a guarantee of payment. I do show she is the spouse of the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's office and outpatient surgery done the same day in the specialist office.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $2500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year. With this being a supplemental policy to the primary health care insurance when the claim is submitted to us for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal in which you should be able to check claim status and that website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then are they covered for the office visit or that's included in the 2500.
[AGENT][NEUTRAL] Of yes, that would be part of the outpatient benefit. It's not a separate benefit.
[CUSTOMER][NEUTRAL] It's not separate, OK, and how much have they met out of the 2500?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And this is for this calendar year that you're needing this information?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, as of now I do not show where she has used any of her calendar your benefits as of now.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK, [PII], that'll be all if you could just provide me a reference for.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Sure, you would choose my name along with today's date.
[AGENT][POSITIVE] And if that is all I can help you with, [PII], and thank you for calling APL and I hope that you have a great afternoon.
[CUSTOMER][POSITIVE] OK perfect
[CUSTOMER][POSITIVE] You too thank you so much.
[AGENT][POSITIVE] You're welcome and thank you as well.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.