AccountId: 011433970860
ContactId: 8926d06b-ca19-4717-9ee8-3e467b392157
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 255360 ms
Total Talk Time (AGENT): 141054 ms
Total Talk Time (CUSTOMER): 52880 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/8926d06b-ca19-4717-9ee8-3e467b392157_20250528T20:17_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], I'm calling to verify outpatient hospital benefits.
[AGENT][NEUTRAL] OK, you're needing to verify outpatient hospital benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] I have 01954728.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] And any information that I do provide for you 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] and it's [PII].
[AGENT][NEUTRAL] OK, thank you. So this policy number that you provided for me, it's an old policy that's no longer active for you. uh, this policy was in effect from.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And there is another policy that is active. This policy that is active, that policy number is 259-514-9.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[CUSTOMER][NEUTRAL] Does it have the ML 8 at the end?
[AGENT][NEUTRAL] The ML8 or ML7 is just differentiates whether inpatient or outpatient. For us, the policy number is the first part of the number before the ML.
[CUSTOMER][NEUTRAL] OK, alright, so 259-514-9 is the member ID.
[AGENT][NEUTRAL] Yes, ma'am, that is correct. Mhm. And give me just one moment to get the uh benefit information pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum per calendar day for covered outpatient services is $500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK, 500 per calendar day and is authorization required on this plan?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, it is not. since it is a supplement, there is no prior authorization required, but when the claim is filed with APL for review, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK, so no others required.
[AGENT][NEUTRAL] And then
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And then once we have processed our claim here, we do have a portal that you should be able to check our claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Thank you. So I'm just wanna um reconfirm. Effective date is [PII], and the patient has coverage for $500 per calendar day. No app required.
[AGENT][POSITIVE] For covered outpatient, that is correct.
[CUSTOMER][NEUTRAL] Alright, thank you [PII] can I get the first initial to your last name and a reference for the call?
[AGENT][NEUTRAL] S as in [PII] and my name and today's date will be your call reference number.
[CUSTOMER][POSITIVE] All right you have a great day thank you.
[AGENT][POSITIVE] OK. Well, you're very welcome, [PII]. So again, if that's all I can help you with, thank you very much for calling APL and I do hope you have a nice evening also.
[CUSTOMER][POSITIVE] You too thank you bye.