AccountId: 011433970860
ContactId: 89a81dee-4d58-4d39-adb2-62883d4ef762
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269140 ms
Total Talk Time (AGENT): 129316 ms
Total Talk Time (CUSTOMER): 76649 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/89a81dee-4d58-4d39-adb2-62883d4ef762_20250423T20:47_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] how are you?
[AGENT][NEUTRAL] I'm fine and you?
[CUSTOMER][POSITIVE] I'm doing great.
[AGENT][NEUTRAL] Yeah, well, how can I help you?
[CUSTOMER][NEUTRAL] I'm calling in regard
[CUSTOMER][NEUTRAL] Yeah, just to verify outpatient benefit for a mutual patient.
[AGENT][NEUTRAL] OK, you're needing to verify benefits. Do you also need eligibility or just benefits?
[CUSTOMER][NEUTRAL] Uh, no, just benefit, it's for out, um, outpatient.
[CUSTOMER][NEUTRAL] Facility.
[AGENT][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] And can I please have the first initial of your last name?
[AGENT][NEUTRAL] [PII], and the first name is [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][POSITIVE] Oh, OK. OK. All right. Thank you so much. Sorry about that. Um, patients, um, policy is 0255.
[AGENT][NEUTRAL] You're welcome. And who am I speaking with?
[AGENT][NEUTRAL] OK, first, no, ma'am. OK, give me just a moment. No, ma'am, hold on one moment. Who am I speaking with, please?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh my name is [PII].
[CUSTOMER][NEUTRAL] It's [PII] Yeah, [PII]
[AGENT][NEUTRAL] Can you spell your name? Uh-huh.
[AGENT][NEUTRAL] OK. [PII]. Thank you. And your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And now the patient's policy number, please.
[CUSTOMER][NEUTRAL] 02556445
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and any information is Sansa that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Oh no you're welcome.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient, you said you needed outpatient benefits, is that correct for facility?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum.
[AGENT][NEUTRAL] Per calendar year for covered out is $8700.
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] OK, has she met any?
[CUSTOMER][NEUTRAL] OK, and has she used any this year?
[AGENT][NEUTRAL] I can check that for you, one moment.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Uh-huh, you're welcome.
[AGENT][NEUTRAL] And no, ma'am, she has not used any benefits for this calendar year.
[CUSTOMER][POSITIVE] Wonderful. OK.
[AGENT][NEUTRAL] Now, because this is a supplemental policy to her primary insurance, when the claim is submitted to APO for review, we will also have to have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK dokey.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once we have processed our claim, we do have a portal in which you should be able to check our claim status and the website for that is secured. Am.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much, Ms. [PII]. You have a great afternoon.
[AGENT][POSITIVE] Well, you are certainly very welcome. Yes, ma'am, you too. Is there anything else as far I can help you with?
[CUSTOMER][POSITIVE] No, that's it thank you so much.
[AGENT][POSITIVE] OK, you're certainly welcome. And again, thank you for calling APL. Have a wonderful evening. You too.
[CUSTOMER][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] You bye bye.