AccountId: 011433970860
ContactId: 795d519d-55f8-468e-9679-0719a4a201d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198210 ms
Total Talk Time (AGENT): 103247 ms
Total Talk Time (CUSTOMER): 69874 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/795d519d-55f8-468e-9679-0719a4a201d3_20250213T13:22_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] [PII] so.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from Baptist. I'm not sure I chose the correct options. I just need to verify the benefit for a patient that we have.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, [PII], do you also need eligibility and benefits or just benefits?
[CUSTOMER][NEUTRAL] I just want to the benefit I would say.
[CUSTOMER][NEUTRAL] She's getting uh an X-ray. I just want to know if her co-payment is covered by you guys.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It's gonna be 02284016 M as in Mary, L as in lion and 8.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Oh
[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 date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so on the supplemental policy she is covered as the spouse of the subscriber and you said you were needing outpatient benefits. Is this gonna be done at a facility?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient benefits.
[AGENT][NEUTRAL] Uh, will she be having her X-ray done at a facility?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum of $1000 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For covered outpatient services per person and there is no outpatient deductible for covered person per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect thank you so much uh a reference for this call please.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date and just a couple of additional things [PII] because this is a supplemental policy to our primary insurance. When the claim is submitted to APL for review, we must also receive a copy of her primary insurance company's explanation of benefits as well. And then once we have processed our claim, we have a portal that you should be able to check claim status and have access to the EOB for us by going to secured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. Remind me your name?
[AGENT][NEUTRAL] [PII] and my name and today's date will be your call reference number. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Exactly [PII] OK perfect [PII] thank you so much have a wonderful day, OK?
[AGENT][POSITIVE] Thank you. I hope you do too, and thank you again for calling APL yes ma'am.
[CUSTOMER][NEUTRAL] You bye.
[CUSTOMER][POSITIVE] Bye bye. You're welcome bye.
[AGENT][NEUTRAL] Bye bye.