AccountId: 011433970860
ContactId: 9cae83f0-b7d0-4280-bf7d-0648dd2a9fbe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312350 ms
Total Talk Time (AGENT): 149609 ms
Total Talk Time (CUSTOMER): 65309 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/9cae83f0-b7d0-4280-bf7d-0648dd2a9fbe_20250619T16:48_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], good afternoon. My name is [PII].
[CUSTOMER][NEUTRAL] And I'm calling from Boca Regional. Hi.
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] I'm calling from Boca Boca Regional pre-registration. I just need to verify some benefits for a patient, please.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, [PII], do you only need benefit information or do you also need eligibility?
[AGENT][POSITIVE] As well, both? OK. Yes, ma'am, I can help you with both and [PII], what is a good callback number for you?
[CUSTOMER][POSITIVE] Yes, eligibility as well, thank you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 955.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Alright, he gave me 02.
[CUSTOMER][NEUTRAL] 555.
[CUSTOMER][NEUTRAL] 997.
[AGENT][POSITIVE] All right, thank you. One moment please.
[AGENT][NEUTRAL] And I see, any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's uh the birthday is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um the name is, uh first name is [PII]
[CUSTOMER][NEUTRAL] My last name is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, outpatient hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $7500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Has he met any of the uh used any of this 7000?
[AGENT][NEUTRAL] It's 7500.
[AGENT][NEUTRAL] And as of now he has used for this calendar year $3,086.40.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, and what is your [PII]? I was gonna ask your name.
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am. That's OK. I get, I have to repeat it a lot all day, so that would have been OK for you to ask me again.
[AGENT][NEUTRAL] And then, um,
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] I was gonna tell you just a couple of additional things, uh, [PII], because this is a supplemental policy to his primary insurance when the claim is submitted to us for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once the claim has been processed by us here at APL we do have a portal that you all should be able to check claim status in.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the website for our portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Is that [PII]?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] All right. All right. Thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that'll be all.
[AGENT][POSITIVE] OK. All right then, well then, thank you for calling APL and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Uh, thank you as well. Bye bye.