AccountId: 011433970860
ContactId: 6b28e992-53ed-4cc5-9e99-06e8c02d62a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288390 ms
Total Talk Time (AGENT): 169670 ms
Total Talk Time (CUSTOMER): 74120 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/6b28e992-53ed-4cc5-9e99-06e8c02d62a2_20250225T20:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Diagnostic Center of Miami, and I was calling for benefits, please.
[AGENT][NEUTRAL] OK [PII], are you also needing eligibility or just benefit information?
[CUSTOMER][NEUTRAL] Um, eligibility as well.
[AGENT][POSITIVE] Yes ma'am, I can help you with both, and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII] option 4.
[AGENT][NEUTRAL] OK, thank you. And then how do you spell your first name with an [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is it S [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK. All right. Thank you. And [PII], what is your patient's policy number?
[CUSTOMER][NEUTRAL] 01612786 M as in Mary L as in Larry and the number 8.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] The 8 is for outpatient or is it 7 for outpatient?
[AGENT][NEUTRAL] Uh, on the ID card, the top one, do you have a copy of the ID card?
[CUSTOMER][NEUTRAL] No, the patient just um just called and gave us the number.
[AGENT][NEUTRAL] OK. All right. Give me just a sec.
[CUSTOMER][NEUTRAL] But I can't remember if the, OK.
[AGENT][NEUTRAL] Yeah, I mean, because really the policy number is just the first part of it, the 01612786.
[AGENT][NEUTRAL] Is the actual policy number itself. But give me just a second and I can tell you. I had a brain cramp on how it looks on the ID card.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] I see, but I can tell you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Like ML 8.
[AGENT][NEUTRAL] It's outpatient, but just one moment.
[AGENT][NEUTRAL] Yes, ML 8 is outpatient.
[CUSTOMER][POSITIVE] OK great.
[AGENT][NEUTRAL] All right, and so one moment.
[AGENT][NEUTRAL] Hey [PII], any information that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And you said that you, she is a subscriber on this policy and yes ma'am, the supplemental plan is active with an effective date of [PII].
[AGENT][NEUTRAL] And are you needing inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Um, outpatient.
[AGENT][NEUTRAL] OK, so the outpatient benefit max per calendar year for covered outpatient services per person is $2500 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Yeah, because this is a.
[CUSTOMER][NEUTRAL] OK, has she met anything yet?
[AGENT][NEUTRAL] I can check that for you and because this is a supplemental policy to her primary insurance when the claim is submitted to us for review, you will also need to include a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal that you should be able to check our claim status and also have access to our EOB by going to [PII].
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] And as of now she has not used any of her outpatient benefits for this calendar year.
[CUSTOMER][POSITIVE] Well thank you.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else, [PII] that I can help you with today?
[CUSTOMER][NEUTRAL] Um, just the, um, a reference number please.
[AGENT][NEUTRAL] OK, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you [PII], enjoy the rest of your day.
[AGENT][POSITIVE] Well, you are certainly very welcome and yes, ma'am. You too. My day is almost over. I hope you're good too.
[CUSTOMER][POSITIVE] Mine too, mine too. I'm counting down. Thank you.
[AGENT][POSITIVE] Well, have a nice day. Yes, yes. OK, well, you're very welcome. And again, thank you for calling.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.