AccountId: 011433970860
ContactId: 835d32d5-6efe-4ac4-b895-babb49708657
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213539 ms
Total Talk Time (AGENT): 107743 ms
Total Talk Time (CUSTOMER): 59706 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/835d32d5-6efe-4ac4-b895-babb49708657_20250221T16:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII]. I was just calling to see to verify benefits for one of our patients.
[AGENT][NEUTRAL] OK, so, do you also need um eligibility or strictly benefits?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh eligibility in the sense of if it's active, yeah, I could verify that as well.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And could you spell your name for me, please?
[CUSTOMER][NEUTRAL] Of course. My name is [PII]. It's spelled [PII].
[AGENT][NEUTRAL] OK, [PII], thank you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] that's gonna be a direct line, no extension needed.
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Policy number would be 01842345M as in Mary L as in Lima 8.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] And [PII], any information that I do provide 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] Of course, patient is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy and it is active. What's an effective date of [PII]?
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's going to be for outpatients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the outpatient benefit max per per calendar day for covered outpatient services per person is $500.
[AGENT][NEUTRAL] And there is no outpatient deductible per calendar day per covered person.
[CUSTOMER][NEUTRAL] OK, so the amount you guys only cover 500 per day?
[AGENT][NEUTRAL] Now, because this
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] That is correct. I've covered outpatient services.
[AGENT][NEUTRAL] And because it is a supplemental policy yearly to the primary insurance, we will also need to receive a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][POSITIVE] OK perfect thank you so much and then so [PII], that was everything I needed and may I just have a reference number for our call?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you will use my name along with today's date and then one last thing really is once we have received and processed our claim here, we do have a portal in which you should be able to check claim status in by going to [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much for all of your help today, [PII] you have a wonderful rest of your day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] I hope you do too you [PII] and thank you again for calling APL.
[CUSTOMER][POSITIVE] Take care, have a wonderful weekend.
[AGENT][POSITIVE] Uh, you too. You too, likewise. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.