AccountId: 011433970860
ContactId: 70a20eb3-ccef-4fee-9265-e0b19835a8bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234619 ms
Total Talk Time (AGENT): 118988 ms
Total Talk Time (CUSTOMER): 52768 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/70a20eb3-ccef-4fee-9265-e0b19835a8bc_20250505T18:03_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] Hi [PII], I'm calling because I need to get benefits on a patient please.
[AGENT][NEUTRAL] OK, do you need eligibility also or just benefit information?
[CUSTOMER][NEUTRAL] And eligibility as well.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with both. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And [PII], what's a good, OK, thank you. And what is a good callback number for you please, [PII]?
[CUSTOMER][NEUTRAL] A provider's office.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] It is 01725691 ML 8.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I did provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on the supplemental policy, and she has an effective date on here of [PII].
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And are you needing outpatient benefits? Is that correct?
[CUSTOMER][NEUTRAL] Um, yes, I'm sorry. She's gonna, yeah, she's gonna be having outpatient surgery at the hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum of $2500 per calendar year for covered outpatient services and there is no outpatient deductible for covered person per calendar year.
[CUSTOMER][NEUTRAL] So, OK, so the 2500, it would cover, let's say deductible and coinsurance?
[CUSTOMER][NEUTRAL] Or just deductible?
[AGENT][NEUTRAL] This plan helps with co-pays, deductibles, and co-insurance amounts of coverage services up to that benefit maximum per calendar year.
[CUSTOMER][POSITIVE] OK perfect and has anything been used?
[AGENT][NEUTRAL] Let's see, just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As of now, no, ma'am.
[AGENT][NEUTRAL] And because this is a supplement to the primary insurance when the claim is submitted to us for review, [PII], we must also have a copy of her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And then once the claim has been processed, we do have a portal in which you should be able to check our claim status and that website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. OK, is there a reference number for the call?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, [PII] 5525 perfect thank you for your help.
[AGENT][POSITIVE] Mhm. Well, you are certainly very welcome and is there anything else I can help you with [PII]?
[CUSTOMER][POSITIVE] No that was it thank you very much.
[AGENT][POSITIVE] Well, you're welcome and thank you for calling APL. I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Uh-huh, thank you. Bye bye.