AccountId: 011433970860
ContactId: 863f3cb9-d2b1-4c22-8f10-dcbf38ccbd36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303230 ms
Total Talk Time (AGENT): 149693 ms
Total Talk Time (CUSTOMER): 60726 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/863f3cb9-d2b1-4c22-8f10-dcbf38ccbd36_20250509T12:05_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] Good morning [PII]. I'm calling because I need benefits on a patient please.
[AGENT][NEUTRAL] OK, so you only need benefit information and not eligibility, is that correct?
[CUSTOMER][NEUTRAL] Well, actually, both, yeah.
[AGENT][NEUTRAL] You do need both?
[CUSTOMER][NEUTRAL] Yes, [PII], can I have the initial to your last name?
[AGENT][NEUTRAL] Yes, I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] And yes ma'am, you're welcome and I can help you with this, and who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII]. That's [PII]
[AGENT][NEUTRAL] First initial to your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and you're sending, what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] 02325489 ML 8
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so you send it first off I need to give you a new policy number for that member. Well, let me back this up. What's your is your data service for a future data service?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That you're needing information.
[CUSTOMER][NEUTRAL] It's going to be for yeah it's gonna be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so the policy number you gave me is no longer active. It termed as a 312025. Give me just a moment to.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, and any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth, first off?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so the new policy number that's currently active as of [PII].
[AGENT][NEUTRAL] It's 259.
[AGENT][NEUTRAL] 8266.
[AGENT][NEUTRAL] And again, effective date is [PII]. And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient, so the policy number is 259-826-6 that's all?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Uh-huh, you're welcome.
[CUSTOMER][NEUTRAL] Is there a group number?
[AGENT][NEUTRAL] The group number did not change.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] 25898.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $500.
[AGENT][NEGATIVE] And there is no output.
[CUSTOMER][NEUTRAL] Per year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year and because this is a supplemental policy you sent in we will.
[AGENT][NEUTRAL] have to have a copy of the primary insurance company's explanation of benefits along with the claim.
[AGENT][NEUTRAL] And once we've processed the claim here at APL, you should be able to check claim status in our portal by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] All right, well, is there.
[CUSTOMER][NEUTRAL] So 500 per year has any of that 5 has any of the 500 been used?
[AGENT][POSITIVE] I can check that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] As of now, no, ma'am. I do not show that any benefits have been used under this policy.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, [PII], can I have a reference number for our call if you don't mind.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect. OK, thank you so much, [PII] have a great day.
[AGENT][POSITIVE] Well, yeah, I hope you have a great day too, [PII], and if that is all I can help.
[AGENT][POSITIVE] Do with, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.