AccountId: 011433970860
ContactId: 8541fbeb-4f4e-4383-b0fd-329832ba538d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243559 ms
Total Talk Time (AGENT): 135169 ms
Total Talk Time (CUSTOMER): 57713 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/8541fbeb-4f4e-4383-b0fd-329832ba538d_20250501T16:45_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's [PII]. I'm trying to get um members outpatient benefits for a gap plan.
[AGENT][NEUTRAL] OK, and you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK, thank you. And you're needing to get benefit information for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that, [PII], and do you also need eligibility or only benefits?
[CUSTOMER][NEUTRAL] Um, only benefits.
[AGENT][POSITIVE] OK, yes ma'am, and what I can help you. What is your call back number?
[CUSTOMER][NEUTRAL] [PII] correct?
[AGENT][NEUTRAL] Thank you and what is the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Mhm. 01611843 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and any, any information that is provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Mhm. [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, so yes ma'am, she is covered under this policy as the spouse of the subscriber and on the supplemental policy, what type of benefit information again do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Outpatient, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $1500 and there is no outpatient deductible for covered per person per calendar year.
[AGENT][NEUTRAL] And because this is a supplemental policy in me to their primary insurance when the claim is submitted to us for review, we will also have to have a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As along with the claim.
[AGENT][NEUTRAL] And then uh once we have processed, yes ma'am, once we have processed our claim here at APL, we do have a portal in which you should be able to check claim status and for us, and the website for our portal is located at [PII].
[CUSTOMER][POSITIVE] Mhm, no problem.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Thank you, um, and you said that for, um, her 1500 max she hasn't used any as of yet?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] I didn't check that for you, but I can.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is what her maximum calendar year benefit is. So give me just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And as of now, no ma'am, she has not used any of her calendar benefits for this calendar year.
[CUSTOMER][POSITIVE] Thank you so much [PII] by any chance do you have a reference number?
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][POSITIVE] Uh, yes, ma'am, you're actually gonna use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. I hope you have a nice day. Enjoy the rest of your week.
[AGENT][POSITIVE] Oh, you're welcome. Well, uh thank you so much. I hope the same things for you [PII], and if that is all I can help you with, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.