AccountId: 011433970860
ContactId: 70617fc3-3aea-4f22-8519-4f08f7b00bb0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229669 ms
Total Talk Time (AGENT): 123967 ms
Total Talk Time (CUSTOMER): 53513 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=2.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/70617fc3-3aea-4f22-8519-4f08f7b00bb0_20250502T16:58_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm sorry, what was your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry, you said [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII] Thank you. I'm sorry. I could hear you.
[AGENT][NEUTRAL] OK. No, ma'am. I'm not, I'm sure you're not. Yes, my name is spelled [PII].
[CUSTOMER][NEUTRAL] Oh [PII].
[CUSTOMER][NEUTRAL] Thank you, [PII]. My name is [PII]. I'm sorry, I couldn't hear you. It's just that there's a lot of echo. So I'm trying to understand what you're trying to say. I'm sorry. I'm calling from a hospital.
[AGENT][NEUTRAL] Yes, ma'am, you're very clear on my end. Uh-huh. Mhm.
[CUSTOMER][NEUTRAL] I'm calling from a hospital. I need to verify coverage for outpatient hospital services for a patient, please.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, [PII], do you need eligibility and benefits?
[CUSTOMER][NEUTRAL] Please
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] 02565943.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you you any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] I'm calling for Ms. [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the subscriber on the supplemental policy and it is active with an effective date of [PII]. And you said that you were needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So she has an outpatient benefit maximum of $8500 per calendar year for covered outpatient services and there is no deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a supple.
[CUSTOMER][NEUTRAL] Would you be able to tell me if anything has.
[CUSTOMER][NEUTRAL] Anything has been applied?
[AGENT][NEGATIVE] As of now, no ma'am, no benefits have been used for this calendar year.
[AGENT][NEUTRAL] And because this is a supplemental plan to her primary insurance, when the claim is filed with APL we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here we do have a portal that you should be able to check claim status in for us by going to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Wonderful.
[CUSTOMER][POSITIVE] Thank you for all that information, [PII]. I think I got everything I needed.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][POSITIVE] OK, well, if that is all then that I could help you with today, [PII], thank you for calling APO and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Yes ma'am you too great weekend.
[AGENT][POSITIVE] Thank you. Yes, ma'am. Thank you so much. Uh-huh. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.