AccountId: 011433970860
ContactId: 8820a9ab-1a2c-4ca1-8b90-84cb460f1e81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 587330 ms
Total Talk Time (AGENT): 221016 ms
Total Talk Time (CUSTOMER): 105296 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/8820a9ab-1a2c-4ca1-8b90-84cb460f1e81_20250424T17:29_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling.
[AGENT][NEUTRAL] APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, I was just calling to verify benefits and eligibility.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefit information for one member? Is that correct?
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry. Give me the last 4 numbers and your extension again please.
[CUSTOMER][NEUTRAL] Uh, the last four is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, D as in Delta 41203547.
[AGENT][NEUTRAL] OK, thank you, but [PII], that's not an APL number, that is a 90 degree benefit number.
[AGENT][NEUTRAL] Do you know if the member also has a policy?
[CUSTOMER][NEUTRAL] OK, yeah, so I just got off the phone with.
[AGENT][NEUTRAL] See with APL or were you trying to actually reach 90 degree but.
[CUSTOMER][NEUTRAL] No, so I just got off the phone with 90 degree benefit and they are.
[CUSTOMER][NEUTRAL] They referred me to you and said that the the member has a APL plan.
[AGENT][NEUTRAL] But they, but you don't have the ID number for APL?
[CUSTOMER][NEGATIVE] Uh, they didn't provide that to me, no.
[AGENT][NEUTRAL] And it's not on the member's ID card?
[CUSTOMER][NEUTRAL] That's the only ID number that I have um was the.
[CUSTOMER][NEUTRAL] The one starting with D.
[AGENT][NEUTRAL] OK. Um, OK, and that's not our number, so, OK, um, do you have the full social for the subscriber, [PII]?
[CUSTOMER][NEUTRAL] Uh, I don't have the full social. I have the last four of the social name and, uh, date of birth, their address.
[AGENT][NEUTRAL] OK, I can try to search by the name. I can't search by date of birth. What is the patient's name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry, what is the last name?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] And first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Like the seasons.
[AGENT][NEUTRAL] That's OK. Just a moment.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Are you able to hear me OK?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so just a moment.
[AGENT][NEUTRAL] What state does the uh member live in?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I mean [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, OK, thank you. And then is this, what type of policy are you calling about for benefits and eligibility?
[CUSTOMER][NEUTRAL] Uh, it's for inpatient mental health.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today would be a verification of.
[AGENT][NEUTRAL] Benefits and not a guarantee of payment. What is her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So she is the subscriber on this limited benefit plan?
[AGENT][NEUTRAL] And it is active with an effective date of [PII].
[AGENT][NEUTRAL] And the policy number that you should have for APL.
[AGENT][NEUTRAL] Is 259.
[AGENT][NEUTRAL] 2651.
[AGENT][NEUTRAL] And give me just a moment to check benefits, please.
[CUSTOMER][NEUTRAL] Is there a group number?
[AGENT][NEUTRAL] 70,030.
[AGENT][NEUTRAL] OK, so limited benefits and she has a hospital confinement.
[AGENT][NEUTRAL] of $100.
[AGENT][NEUTRAL] And for mental health, it is a maximum of 30 days per calendar year.
[AGENT][NEUTRAL] Actually, it states the exact verbiage states benefits will not exceed the maximum total benefit of 30 days for any one period of confinement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, do they have like a deductible out of pocket maximum?
[AGENT][NEUTRAL] Um, [PII], yes, ma'am.
[AGENT][NEUTRAL] This is not major medical insurance. This is a limited benefit plan.
[AGENT][NEUTRAL] So again the benefit amount, yes, would be $100 a day per day and a max of 30 days for any one period of confinement.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And once the claim has been processed, [PII], there is a portal that you should be able to check claim status in.
[AGENT][NEUTRAL] And the website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK, is there a claims address?
[AGENT][NEUTRAL] For this member's policy, claims will be mailed to IMA.
[AGENT][NEUTRAL] At [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 55.
[AGENT][NEUTRAL] 121.
[AGENT][NEUTRAL] And ID 64556.
[CUSTOMER][NEUTRAL] And I'm sorry, can you repeat the last?
[CUSTOMER][NEUTRAL] Those last numbers?
[AGENT][NEUTRAL] The payer ID is 64556.
[CUSTOMER][NEUTRAL] Alright, and what does IMA stand for?
[AGENT][NEUTRAL] I honestly could give, I don't know that's all of the information I I have is the name of the company is IMA.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] OK, so do, do we need to send in like a prior off for this certain plan?
[AGENT][NEUTRAL] No, ma'am, because it's, you know, because there's no, if this isn't major medical insurance, again, it's only a limited benefit plan.
[AGENT][NEUTRAL] So there is no prior authorization required.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right, um.
[CUSTOMER][NEUTRAL] Let me see, I think I guess that's it, uh, can I get the initial to your last name and a reference number?
[AGENT][NEUTRAL] Yes, my name along with today's date would be your reference number and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] OK. Well, you're welcome, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Um, no, I think that's it, thank you.
[AGENT][POSITIVE] OK well you're very welcome and thank you again.
[AGENT][POSITIVE] Thanks for calling [PII]. I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.