AccountId: 011433970860
ContactId: 981840b0-082d-48ad-9c55-aee727363c2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349220 ms
Total Talk Time (AGENT): 147131 ms
Total Talk Time (CUSTOMER): 92530 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=2.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/981840b0-082d-48ad-9c55-aee727363c2e_20250122T21:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Hello, this is [PII]. I'm calling on a recorded line for quality and training purpose for Doctor [PII].
[CUSTOMER][NEUTRAL] I need to obtain medical benefits and eligibility for our patients.
[AGENT][NEUTRAL] OK, you need benefits and eligibility for one patient, is that correct, [PII]?
[CUSTOMER][POSITIVE] You're correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Well, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] 01852130 M as in Mike L as in Lima, the number 8.
[AGENT][NEUTRAL] Thank you. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and following the information 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] Well, the patient name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So I do show she is the subscriber on this supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her all inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] I said [PII], on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $7000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. Uh.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Can I know what is the specific plan name?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Medlink.
[AGENT][NEUTRAL] This is a supplemental policy.
[CUSTOMER][NEUTRAL] So, uh, is there any other name like alphabetical name? Panj?
[AGENT][NEUTRAL] No, so we're not a major medical, no, so we're not a major medical insurance company.
[AGENT][NEUTRAL] This is a supplemental plan.
[CUSTOMER][NEUTRAL] Here in, but I have records, I have records here. It is non-standard supplement plan.
[AGENT][NEUTRAL] This is a supplemental policy that helps with co-pays, deductibles and co-insurance amounts of covered services.
[AGENT][NEUTRAL] So when the claim is submitted to us for review, [PII], we must also receive a copy of her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] For review
[CUSTOMER][NEUTRAL] One moment, please.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And then also, uh-huh.
[CUSTOMER][NEUTRAL] Is there any, is there any group number for billing purpose?
[AGENT][NEUTRAL] Did you ask for the group number?
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] 24,050.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then lastly, uh, [PII], once we have processed the claim at APL, we do have a portal in which you should be able to access the claim status and the explanation of benefits for APL by going to our portal at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much for providing me.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um, can I have, can I have a, uh, can you spell out your name? and can I have a reference number?
[AGENT][NEUTRAL] The reference number would be my name along with today's date. My name is spelled [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for providing me assisting with information. Have a great day. Take care. Bye for now. Thank you so much.
[AGENT][NEUTRAL] When is there.
[AGENT][POSITIVE] Well, well, I hope you have a nice. You're welcome, [PII] and thank you again for calling APL. I hope you have a nice, uh, rest of your day as well.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.