AccountId: 011433970860
ContactId: 75c39f5b-b002-47dd-a1cc-27e1453fef82
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219770 ms
Total Talk Time (AGENT): 119829 ms
Total Talk Time (CUSTOMER): 46294 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/75c39f5b-b002-47dd-a1cc-27e1453fef82_20250604T18:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits and eligibility for one of our patients, please, and you said your name is?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][NEUTRAL] And you said that you're needing
[AGENT][NEUTRAL] OK, [PII], thank you. And you're needing benefits and eligibility for one patient, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes, [PII], I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] It's gonna be 01810039 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And [PII], any information that I do provide today will be a verification of benefits and not a guarantee of payment. What is the patient's name and their date of birth?
[CUSTOMER][POSITIVE] Perfect, and the patient's name is gonna be [PII].
[CUSTOMER][NEUTRAL] [PII], sorry, um, [PII], and it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So again, any information provided will be a verification of benefits and not a guarantee of payment. I do show that she is the subscriber on the supplemental policy, Mila. It is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office and outpatient surgery.
[AGENT][NEUTRAL] OK. So office visits are not covered under the supplemental policy?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me a moment to get the benefit information for outpatients.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $3000 with no outpatient deductible.
[AGENT][NEUTRAL] And milk because it is a supplemental pump.
[CUSTOMER][NEUTRAL] How much has been accumulated?
[AGENT][NEUTRAL] I can check that and because it is a supplement to the primary insurance, when the claim is submitted to us for review, we will also have to receive a copy of our primary insurance company's explanation of benefits with the claim.
[AGENT][NEGATIVE] And as of now, no benefits have been used for this calendar year as of now.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] Perfect and a reference number please?
[AGENT][NEUTRAL] Would be my name in today's date and then also [PII] once the claim has been processed by APL we have our portal that you all should now be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Alrighty thank you so much you have a great rest of your day.
[AGENT][POSITIVE] Oh, you're welcome. I hope you do too if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.