AccountId: 011433970860
ContactId: 7c453c5c-d673-4b82-83d8-633523f3ea82
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340480 ms
Total Talk Time (AGENT): 142647 ms
Total Talk Time (CUSTOMER): 61576 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=3.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/7c453c5c-d673-4b82-83d8-633523f3ea82_20250312T13:00_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. Uh, my name is [PII]. Uh, I was calling from Texas Digestive disease Consultant. I was wondering if you could help me out to check eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK [PII], you're needing eligibility and benefit information for members, is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] Yes, I can help you with that, and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Yeah, that would be [PII], no extension.
[AGENT][NEUTRAL] OK, thank you. And then what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number is 02.
[CUSTOMER][NEUTRAL] 506-255
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], any information provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes. Her name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show she is the subscriber on the supplemental policy, [PII], and the supplemental policy is active with an effective date of [PII]. And what type of benefit information do you need inpatient, outpatient, or office?
[CUSTOMER][NEUTRAL] Uh, right now she's coming for an office visit with a specialist, but also I would like to know if they have any outpatient surgery benefits.
[AGENT][NEUTRAL] OK, so uh there are no benefits for the office visit. Office visits are not covered under the supplemental policy.
[AGENT][NEUTRAL] But you also said that you were wanting just your general outpatient benefit. Is that correct?
[AGENT][NEUTRAL] For covered services.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I'm sorry, [PII], bear with me just one moment, please.
[CUSTOMER][POSITIVE] No problem, take your time.
[AGENT][POSITIVE] Thank, uh, thank you.
[AGENT][NEUTRAL] I'm sorry, it's just taking a moment to load the information. Thank you for your patience.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so on this policy, the outpatient benefit max Carlos per calendar year for covered outpatient services is $3000.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because this is a supplemental policy to her primary insurance, when the claim is submitted to APL, we will also have to have a copy of her primary insurance company's.
[AGENT][NEUTRAL] Excuse me, we will also need to receive a copy of our primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed our claim, [PII], we do have a a portal in which you should be able to check claim status and our portal website is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright, perfect.
[CUSTOMER][POSITIVE] OK, I really appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that'd be all. Thank you so much. OK, have a great day.
[AGENT][POSITIVE] OK. Well, you're welcome. I hope you have a great day too, and thank you again for calling ATL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.