AccountId: 011433970860
ContactId: 72a0de2f-5942-4cd2-83a6-6d74989553c1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275380 ms
Total Talk Time (AGENT): 126619 ms
Total Talk Time (CUSTOMER): 74086 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/72a0de2f-5942-4cd2-83a6-6d74989553c1_20250422T16:52_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, what was your name again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], and can I get the first letter of your last name please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Thank you. I was just calling to verify benefits for a patient.
[AGENT][NEUTRAL] OK, you're needing only benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] If I can help you with that, and who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] And the first initial [PII] to your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It is 02611461.
[AGENT][NEUTRAL] OK, thank you, and you do not need eligibility, you only need benefits, is that correct?
[CUSTOMER][POSITIVE] Yeah, benefits.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh her name is [PII] Her last name and her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so, uh, she is covered on this policy as the spouse. What type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient?
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum on this policy for covered outpatient services of $6500 per calendar year.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK. And has she met any
[AGENT][NEUTRAL] And because this is a
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I was just gonna say that because it is a supplement to her primary insurance. On the when a claim is submitted to us for review, we will also.
[AGENT][NEUTRAL] They have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we've processed the claim here at APL, Ashley, we have a portal you should be able to check claim status in and our website for the portal is [PII].
[CUSTOMER][NEUTRAL] Let's see
[AGENT][NEUTRAL] And to answer your question, as of now, she has not used any of these outpatient benefits for this calendar year.
[CUSTOMER][NEUTRAL] OK, so she has this.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, perfect. So just to review everything, she has a $6500 max that she's able to use after the primary insurance covers.
[CUSTOMER][NEGATIVE] Um, no deductible.
[CUSTOMER][NEUTRAL] Um, OK, is that correct?
[AGENT][POSITIVE] That is correct for you, ma'am.
[AGENT][NEUTRAL] And then we must receive a copy of the primary insurance EOB with the claim.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] That is required for reviewing these claims.
[CUSTOMER][NEUTRAL] And that is sent by the facility or by the patient?
[AGENT][NEUTRAL] Yes, so whoever is following the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and can I get a reference number please?
[AGENT][NEUTRAL] You would, yes ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK, so [PII] 422 2025.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][NEUTRAL] OK. Well, you're welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be it thank you.
[AGENT][POSITIVE] OK, well, thank you again for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.