AccountId: 011433970860
ContactId: 70cfb641-5ffc-4136-9c44-3928adb9b4b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216160 ms
Total Talk Time (AGENT): 120401 ms
Total Talk Time (CUSTOMER): 73013 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=2.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/70cfb641-5ffc-4136-9c44-3928adb9b4b7_20250304T20:03_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], good morning. Well, sorry, good afternoon. My name is [PII]. I'm calling from the Diagnostic Center of Miami. How are you doing today?
[AGENT][NEUTRAL] I'm good. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][POSITIVE] [PII] OK, thank you. I'm so sorry. OK, myself, how are you today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I'm doing well, thank you for asking. No worries, I have many issues with my name always.
[AGENT][NEUTRAL] I have, people get my name wrong all the time too, so I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, no, no, no problem, and I just need to obtain benefits and eligibility for one of my patients please, outpatient benefits.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, you're needing eligibility and outpatient benefits for members, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes, yes, that's all.
[AGENT][POSITIVE] Yes, I can help you with that. I can help you with both. And what is a good callback number for you, please? Oh, you're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII] option 4.
[AGENT][NEUTRAL] OK, thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Yes, 01845857, M like Mary, L like Larry, and the number 8 and the end.
[AGENT][NEUTRAL] OK. OK. Thank you. One moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Hi [PII], 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] My first name is [PII], last name [PII], on [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this supplemental policy is active. She is the subscriber and the effective date on the plan is [PII].
[AGENT][NEUTRAL] And what type of benefit you said outpatient, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Outpatient benefit, yes, right, you're correct, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the outpatient benefit max per calendar year for covered outpatient services is $1000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. May I have a reference number for this call, please?
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's state and Mars, a couple of different just two more things for me to let you know. One, we will need to have a copy of the primary insurance company's explanation of benefits along with the claim for reviews since this is a supplemental policy.
[CUSTOMER][NEUTRAL] Mhm.
[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 our claim status by going to [PII].
[CUSTOMER][POSITIVE] All right, OK, no problem.
[AGENT][NEUTRAL] OK. And again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, [PII], thank you so much. You have a wonderful afternoon. Mhm bye-bye.
[AGENT][POSITIVE] Well, yes ma'am you too and thank you again for calling APL.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Bye bye thank you bye bye.
[AGENT][POSITIVE] Mhm, you're welcome