AccountId: 011433970860
ContactId: 7665d3a6-9a4e-460b-a5a4-ee70ef5dfde9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197369 ms
Total Talk Time (AGENT): 95119 ms
Total Talk Time (CUSTOMER): 47887 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/7665d3a6-9a4e-460b-a5a4-ee70ef5dfde9_20250207T15:44_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, [PII]. My name is [PII]. I'm calling from Baptist Outpatient Services. I needed to check, uh, outpatient benefits for a mutual patient of ours.
[AGENT][NEUTRAL] OK, [PII], do you also need um eligibility or only outpatient benefits?
[CUSTOMER][NEUTRAL] Uh, eligibility as well, please.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yes, so the policy number is going to be 02493164.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, any information, [PII] that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So I do show she is the subscriber on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And her outpatient benefit mas per calendar year for covered outpatient services is $6000 with no outpatient deductible.
[AGENT][NEUTRAL] And when the claim is submitted with to APL for review, we must also have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim, we have a portal, Alejandra, where you can check claim status and have access to our EOB and that portal website for us is secured. [PII].
[CUSTOMER][NEUTRAL] OK, can you tell me uh what her accumulations are so far for this calendar year?
[AGENT][NEUTRAL] As of now, yes, ma'am, as of now, there are no claims. She has not used any benefits.
[CUSTOMER][POSITIVE] OK, perfect, thank you so much, [PII]. Is there a reference number for the call?
[AGENT][NEUTRAL] Yes, she would use my name and along with today's date.
[CUSTOMER][POSITIVE] Perfect thank you so much I appreciate your help.
[AGENT][POSITIVE] Well, you are certainly very welcome and if that's all I can help you with, and thank you again for calling ATL and I hope you have a very nice weekend.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.