AccountId: 011433970860
ContactId: 90b85bd6-7869-462e-bda7-ff39a2a5563f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293500 ms
Total Talk Time (AGENT): 140143 ms
Total Talk Time (CUSTOMER): 53416 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/90b85bd6-7869-462e-bda7-ff39a2a5563f_20250416T18:46_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I need to check, um, patients benefits, please.
[AGENT][NEUTRAL] And you're needing benefits only. You do not need eligibility, is that correct?
[CUSTOMER][NEUTRAL] Um, well, I, yeah, I need to also find out if he's eligible. I'm sorry.
[AGENT][POSITIVE] OK, yes, I can help you with both. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] Um, the only ID number that I see there is in 80047.
[AGENT][NEUTRAL] OK. That's gonna be a group number. There should be another number on the ID card.
[CUSTOMER][NEUTRAL] Um, I don't have an ID card for him. Um, can I give you his social?
[AGENT][NEUTRAL] Yes, ma'am, if he's a subscriber.
[CUSTOMER][NEUTRAL] Yes, he is the um the subscriber. His um number is [PII].
[AGENT][POSITIVE] OK, thank you. Give me a moment, [PII] to see if I can um.
[AGENT][NEUTRAL] Locate that. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's for [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] The number that you should have is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again you said you were needing inpatient, outpatient or office? I believe you said outpatient.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, it's for inpatient.
[AGENT][NEUTRAL] An in-hospital admission? OK, I'm gonna send her I thought she said outpatient.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The inpatient benefit maximum per calendar.
[AGENT][NEUTRAL] Uh, wait, let me, let me look at one thing.
[AGENT][NEUTRAL] Before I tell you that.
[AGENT][NEUTRAL] Just one moment, it's still trying to load some information for me, [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the in-hospital benefit maximum is $2000 per cover person per confinement, and there is no in-hospital deductible per covered person per confinement.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And because this is a supplement to the primary insurance, we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and has he maxed out his $2000 yet?
[AGENT][NEUTRAL] Well it's per confinement.
[CUSTOMER][NEUTRAL] Oh, OK, so it's OK, so it's per OK, no, I understand. OK, no problem. Thank you.
[AGENT][NEUTRAL] Yes sir, you're welcome. And then once we've processed our claim here at APL, we do have a portal, [PII], that you should be able to check our claim status in, and the website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] No, that's it, thank you, and I'm sorry, what was your first name again? I apologize.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII], thank you, [PII], I appreciate it.
[AGENT][NEUTRAL] And you'll use my name and today's date as your reference number. You're welcome.
[AGENT][POSITIVE] So again, if that's all I can help you with. Oh, I hope you do too, and thank you again for calling APL today, [PII].
[CUSTOMER][POSITIVE] All right thank you you enjoy the rest of your day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.