AccountId: 011433970860
ContactId: 71459d1f-d37b-4426-950c-515caacaa6b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231000 ms
Total Talk Time (AGENT): 110093 ms
Total Talk Time (CUSTOMER): 47157 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/71459d1f-d37b-4426-950c-515caacaa6b8_20250610T13:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling from a provider's office. I need benefits on a patient please?
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII] mhm.
[AGENT][NEUTRAL] OK, thank you. And you're needing eligibility and benefits or just benefits?
[CUSTOMER][POSITIVE] Correct benefits and yeah eligibility both.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh yes, ma'am. I can help you with both. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 01979752 ML 7.
[AGENT][NEUTRAL] OK, that was 01979752 ML 7.
[CUSTOMER][NEUTRAL] ML. Uh huh yes.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And then any information that is provided 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] It's [PII] [PII].
[AGENT][NEUTRAL] Thank you. So I do show that she is a subscriber on the supplemental policy and it is active. The effective date on the plan is going to be, one moment.
[AGENT][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For outpatient sur surgical procedures, yes.
[AGENT][NEUTRAL] OK, so one moment.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum.
[AGENT][NEUTRAL] is $500 per covered person per occurrence for covered outpatient services and there is no outpatient deductible per covered person per occurrence.
[CUSTOMER][NEUTRAL] OK, so let's suppose the patient is having two procedures at the same time. They pay 500 for each or all together?
[AGENT][NEUTRAL] No, ma'am, this is for a per occurrence and the definition of per occurrence on this member's plan states that it's per occurrence means treatment for the same or related condition.
[AGENT][NEUTRAL] Unless separated by a period of 90 days. Treatment for the same or related conditions separated by 90 days or an unrelated condition will be considered a new per occurrence.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK perfect all right well thank you for your help you have a good day bye.
[AGENT][NEUTRAL] Yes, ma'am, and yes, ma'am. And just a couple more things, [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am, I