AccountId: 011433970860
ContactId: 6cb93e63-92bb-4de2-845f-35e37d015587
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261630 ms
Total Talk Time (AGENT): 138116 ms
Total Talk Time (CUSTOMER): 45202 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/6cb93e63-92bb-4de2-845f-35e37d015587_20250303T21:01_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. I'm calling on behalf of Homestead Hospital to verify member eligibility and benefits for an ER visit with us.
[AGENT][NEUTRAL] OK, you're needing to verify eligibility and benefits for benefits for members, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, sir, I can help you with that and who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you and um well, what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please, Amar.
[CUSTOMER][NEUTRAL] 02556467 M as in Michael, L as in Lima and the number 7.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And no more, any information that I may provide for you today would 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] [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I do show she is a subscriber Omar on this supplemental policy, and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And again you said that you were needing outpatient.
[AGENT][NEUTRAL] Emergency room visits, benefits, is that correct? OK.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is 8,7 excuse me, $8700.
[AGENT][NEUTRAL] And there is no ER deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] Alrighty and what is the group name?
[AGENT][POSITIVE] And actually it's not per calendar year, it's per occurrence. I'm so sorry about that.
[CUSTOMER][NEUTRAL] Oh, per current.
[AGENT][NEUTRAL] Yes, sir. Mhm. And per occurrence means the same or related condition unless separated by a period of 90 days or a separate condition.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alrighty and the group name?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] The group name is Sunshine Gasoline.
[AGENT][NEUTRAL] Distributors Incorporated.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you all will be filing a claim with APO on this policy, we will also have to have a copy of our primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then once we've processed our claim, [PII], we do have a portal that you should also be able to check our claim status in and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] OK, very well, and is there a group number on the plan?
[AGENT][NEUTRAL] Group number is 80094.
[CUSTOMER][POSITIVE] Alrighty, I thank you for your time today.
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No ma'am, that'll be all thank you.
[AGENT][POSITIVE] OK, um well, well, you're very welcome and thank you again for calling APL. I hope you have a nice evening.
[CUSTOMER][POSITIVE] Good day bye.
[AGENT][NEUTRAL] Uh, you too. Bye-bye.