AccountId: 011433970860
ContactId: 87dc31ed-ff68-43ee-8f59-0ee294fb3805
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347910 ms
Total Talk Time (AGENT): 186753 ms
Total Talk Time (CUSTOMER): 124608 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/87dc31ed-ff68-43ee-8f59-0ee294fb3805_20250219T18:15_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from the doctor's office.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Hi [PII], how can I help you today?
[CUSTOMER][NEUTRAL] Yes, I want on the patients benefits. So, could you help me on this, [PII]?
[AGENT][NEUTRAL] I'm sorry, what was your question? I didn't understand you.
[CUSTOMER][NEUTRAL] I need to check the patient's medical benefits.
[AGENT][NEUTRAL] OK, you're needing medical benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that. And you did say your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, your name, yes, your name is [PII], right?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], what is your callback?
[CUSTOMER][NEUTRAL] See I see
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry, let me spell my name again for you. [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] The member policy number I have 01885487 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Any information that I do provide for you today, and it will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] I'm sorry, what was, you said his first name was [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] And date of birth again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, now on this policy there is no one by that name or date of birth. This policy is no longer active. This policy was effective from [PII]. Let me see if there's another policy there is.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So I need to give you the correct policy number that you should have.
[CUSTOMER][NEUTRAL] Yes, go ahead with the policy number.
[AGENT][NEUTRAL] 02335900.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] This is the policy number 02335905900. That's it.
[AGENT][NEUTRAL] 02335900
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And he is a dependent on this policy. Again, the policy is active with an effective date of [PII]. And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Hold on a moment.
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] OK. The outpatient benefit maximum for covered outpatient services per covered person is $500 per calendar day and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] And anything used out of the $5000 500 dollars.
[AGENT][NEUTRAL] This is a per calendar day benefit is this for a future date of service? This is not a per calendar year benefit.
[CUSTOMER][NEUTRAL] So it's uh per calendar year maximum coverage is $500 right?
[AGENT][NEUTRAL] No, sir. No, no, sir. It is per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For calendar day coverage, it's $500 right?
[AGENT][NEUTRAL] Per calendar day, the benefit maximum is $500 per covered person for covered outpatient services.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So this accumulation amount of $500 right?
[AGENT][NEUTRAL] That is the maximum benefit per calendar day.
[CUSTOMER][NEUTRAL] All right. One moment, can you hold on a second?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Is it per calendar year or per calendar day?
[AGENT][NEUTRAL] No, sir. OK. I've explained to you several times, [PII], this is per calendar day, not per calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Per day, right?
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And because this is a supplemental policy to the primary insurance, if you file a claim with us on this policy, you will also need to include a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And then once we have processed our claim, you may check status and print our EOB by going to secured.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] On that, no, no, sir. Thank you so much, sir. Can I have the contact number?
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][POSITIVE] That's it. Thank you so much. That is the information needed. You have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Alright, you too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] today.
[CUSTOMER][NEUTRAL] Mhm.