AccountId: 011433970860
ContactId: 8dc94102-2920-4b85-9e7a-76fb9c3192d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273250 ms
Total Talk Time (AGENT): 124610 ms
Total Talk Time (CUSTOMER): 79207 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/8dc94102-2920-4b85-9e7a-76fb9c3192d3_20250106T15:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, good morning. My name is [PII]. I'm calling on behalf of Walker Baptist Medical Center. And the reason why I'm calling is just to verify if um the patient is still active with your insurance. I to check eligibility and benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You do need the benefits also?
[AGENT][POSITIVE] Is that correct? OK, yes, ma'am, I can help you, and I'm so sorry. What was your name again?
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] It's gonna be [PII]. I'll let you uh spell it out. It's [PII], and the initial of my last name is [PII].
[AGENT][NEUTRAL] OK, [PII]. Thank you. And your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm showing here it's 152-635-0.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee.
[AGENT][NEUTRAL] Amen. What is his name and their date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is a subscriber on the supplemental policy. It is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And it is active and give me just a moment to get the benefit information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're gonna need inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] I do show here that this is for an outpatient service here at the facility.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so on the supplemental policy marks, the outpatient benefit max is $4500 per covered person per calendar year for covered outpatient services, and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, thank you. And since you've mentioned that this is just for a supplemental plan, so this will follow the primary insurance, correct? Or the guidelines of the primary insurance?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is no network or prior authorization required with APL?
[AGENT][NEUTRAL] And if something is not covered by the primary, it would not be covered under the supplemental. Also, Mars, with this being a supplemental policy when the claim is filed with the APL for review, we must also have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we do have a portal that you can check our claim status and have access to the EOBs with APL by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] I believe you already covered everything that I need for today, but I just need the your last name to for my documentation purposes.
[AGENT][NEUTRAL] Sure. [PII], and my name and today's date will be your call reference number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. All right, thank you so much for giving that information for me and I hope you have a wonderful day. Bye for now.
[AGENT][POSITIVE] I hope you do too, Mars and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.