AccountId: 011433970860
ContactId: 89674ac0-384f-4b0f-9689-11f26791398b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318619 ms
Total Talk Time (AGENT): 110676 ms
Total Talk Time (CUSTOMER): 156024 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/89674ac0-384f-4b0f-9689-11f26791398b_20250425T21:10_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I was trying to verify eligibility and benefits for mutual patients and, um, I was also trying to verify if prior is required.
[AGENT][NEUTRAL] OK. Well, I can help you with the eligibility and benefits as well as the prior off. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII] and the first initial of my last name is [PII].
[CUSTOMER][POSITIVE] And my phone number is [PII]. Bless you.
[AGENT][NEUTRAL] Thank you for that. [PII]. May I have your I'm sorry, the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's gonna be 01869092.
[AGENT][NEUTRAL] And that was 01869092?
[CUSTOMER][POSITIVE] Yes, that's correct, ma'am.
[AGENT][NEUTRAL] All right. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh-huh. It's a little um odd her last name. It's [PII]. I, I, I'm assuming that's how you pronounce it. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, now, APL doesn't require any prior author pre-cert because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And get all that down.
[AGENT][NEUTRAL] And did you want to go over any particular benefits today?
[CUSTOMER][NEUTRAL] Yes, um, her ambulatory surgical center benefits, if she has any.
[AGENT][NEUTRAL] OK, so for outpatient, the policy will pay up to $2550 per calendar year. Um, did you want me to see if any of the max has been used for this year?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing she's used $516.87. She has $1,983.13 left for [PII].
[CUSTOMER][NEUTRAL] OK. And how much is her
[CUSTOMER][NEUTRAL] Uh, so this is like an, an allowance that they give her?
[AGENT][NEUTRAL] Um, so it's not an allowance. Hold on, let me see. This is her secondary insurance, so we apply to the co-pay, deductible and co-insurance of coverage charges up to that $2500 per calendar year after primary.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. So, insurance will be.
[CUSTOMER][NEUTRAL] And you said 2500, right? Up to 2500.
[AGENT][NEUTRAL] Yes, ma'am. Well, let me double check, hold on one moment.
[AGENT][NEUTRAL] $2550 per calendar year.
[CUSTOMER][NEUTRAL] 0, 2550, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] To, um, propane for insurance.
[CUSTOMER][NEUTRAL] And deductible OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, and then ma'am, can you give me the effective dates one more time?
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the policy um has been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We'll have to.
[CUSTOMER][NEUTRAL] OK. And then just to, um, can I have your name one more time?
[AGENT][NEUTRAL] Sure, my name is [PII] [PII] name [PII] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, and then just a reference number for this call please.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date, and the first initial to my last name, I'm sorry, is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, sounds good [PII] thank you so much I really appreciate you. I think that was all I was needing.
[AGENT][POSITIVE] You're very welcome. Well, thank you so much for calling APLS and I hope you have a great day.
[CUSTOMER][POSITIVE] You too, ma'am. Thank you. Bye bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.