AccountId: 011433970860
ContactId: 94f532f0-03a3-4f73-8b2b-8880d38fe429
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281859 ms
Total Talk Time (AGENT): 154008 ms
Total Talk Time (CUSTOMER): 94360 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/94f532f0-03a3-4f73-8b2b-8880d38fe429_20250430T19:26_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi, good afternoon, my name is [PII] calling to check benefits on one of your members please.
[AGENT][NEUTRAL] OK, [PII], you're needing benefits. Do you also need eligibility or just benefits?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Y'all gonna take us to the front.
[CUSTOMER][POSITIVE] Just the benefits then.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] That's the security guard right there that you need to shuttle.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] What is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number?
[CUSTOMER][NEUTRAL] 02216473
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today would 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] It's for [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 5 weeks pregnant. She just got pregnant.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] a
[AGENT][NEUTRAL] And you said you only needed benefit information, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Alright, do you need inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] It will be
[CUSTOMER][NEUTRAL] Actually, if you guys don't cover emergency?
[AGENT][NEUTRAL] Just for an emergency room that would be considered outpatient, is that correct?
[CUSTOMER][NEUTRAL] Um-hum.
[CUSTOMER][NEUTRAL] Outpatient, OK, yes.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum for covered outpatient services per calendar day is $200.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] of them
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Ohh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And would you mind providing the information for inpatient because I think she's gonna get admitted she's in labor.
[AGENT][NEUTRAL] OK. All right, so give me just, give me just one second to pull up something else on this policy.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] As far as what I was saying on the, um the deductible, the wording on her policy is that there is no outpatient deductible.
[AGENT][NEUTRAL] Per occurrence, I believe. That's what I'm double checking instead of per calendar day, but yes, it's per occurrence for an emergency room visit. The inpatient benefit maximum per calendar year is $1000 with no inpatient deductible per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] For calendar year, OK.
[AGENT][NEUTRAL] Uh-huh. Her outpatient is a per calendar day and her inpatient is a per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And would you mind providing your name and the first letter of your last name?
[AGENT][NEUTRAL] Again, my name is [PII]. First initial to last name is [PII]. And if you all end up filing a claim with usilma for her because it is a.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The supplement to her primary insurance, we will have to have a copy of the primary insurance company's explanation of benefits along with the claim.
[AGENT][NEUTRAL] And then once the claim has been processed by APL we do have a portal that you should be able to check claim status in and the website for that is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much and is there a reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect, thank you so much, ma'am.
[AGENT][POSITIVE] OK. Well, you're certainly very welcome. And is there anything else that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] No ma'am, you've been very helpful thank you so much.
[AGENT][POSITIVE] Well, you're certainly very welcome. It was my pleasure and thank you for calling APL. I hope you have a very nice rest of your day.
[CUSTOMER][NEUTRAL] And you said this the road.
[CUSTOMER][POSITIVE] Same to you thank you bye.
[AGENT][POSITIVE] Thank you too. Bye-bye.