AccountId: 011433970860
ContactId: 7bd48cb0-15ed-4b04-9dd1-2a6f8cfc7fc8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195559 ms
Total Talk Time (AGENT): 99781 ms
Total Talk Time (CUSTOMER): 31820 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/7bd48cb0-15ed-4b04-9dd1-2a6f8cfc7fc8_20250219T19:46_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII]. I'm calling to verify um outpatient radiology benefits.
[AGENT][NEUTRAL] OK, [PII], you're needing outpatient benefits. You said for radiology, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and what is the member's policy number that you're calling on behalf of?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 02509837.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] And any information [PII] that I provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on the supplemental policy, and the supplemental policy is active, effective [PII].
[AGENT][NEUTRAL] And one moment on your benefits.
[AGENT][NEUTRAL] She has an outpatient benefit max of $8700 per calendar year for covered outpatient services.
[AGENT][NEUTRAL] With no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK. And has she used any of that um for the year?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh, as of now, no, ma'am, she has not.
[CUSTOMER][POSITIVE] Perfect. And do you have a reference number for the call?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yes, now before I give you that though, when the claim is submitted to APO Marissa, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim, you should be able to check claim status and have access to our EOB and our portal and our portal website is secured.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for your reference number you would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][POSITIVE] OK, well you are certainly welcome. Can I help you with anything else?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.