AccountId: 011433970860
ContactId: 7fd23d20-f748-43b3-80f5-af82228830bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229000 ms
Total Talk Time (AGENT): 128167 ms
Total Talk Time (CUSTOMER): 43276 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/7fd23d20-f748-43b3-80f5-af82228830bf_20250625T14:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, I am looking for, I'm from a provider's office. My name is [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And I'm from Aton Cans Center mhm.
[AGENT][NEUTRAL] OK, and how can I help you, [PII]?
[CUSTOMER][NEUTRAL] Yes, I'm trying to look up um a patient's uh benefits.
[AGENT][NEUTRAL] OK, you're only needing benefit information and not eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes, eligibility as well.
[AGENT][NEUTRAL] I can help you with both and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It's 02457138.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] Any information that I provide today will 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].
[CUSTOMER][NEUTRAL] And her date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is the subscriber on the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so on this supplemental policy, office visits are not covered. However, if there is some form of treatment rendered in the office, we could review the treatment itself under her outpatient benefit maximum.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the outpatient benefit maximum per calendar day for covered outpatient services is $500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if you all in, oh, I was gonna give you just two more things. Should you all end up filing a claim with us, [PII] for her on this policy, we will have to have a copy of the outpatient, I'm sorry, the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL, we do have a portal that you should be able to check your claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] All right, thank you so much I appreciate that.
[AGENT][POSITIVE] Well, you're very welcome. So is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] No, ma'am, that'll be it.
[AGENT][POSITIVE] OK, well then, thank you [PII] for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Alright thank you you too mhm.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.