AccountId: 011433970860
ContactId: 9dc5fe9a-2a2c-4928-bad7-80358fcad3fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229039 ms
Total Talk Time (AGENT): 114892 ms
Total Talk Time (CUSTOMER): 44683 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/9dc5fe9a-2a2c-4928-bad7-80358fcad3fc_20250509T15:17_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]. My name is [PII] and I'm calling to check benefits for a patient, please.
[AGENT][NEUTRAL] OK, [PII], you're needing benefit information for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And do you also need eligibility or only benefits?
[CUSTOMER][NEUTRAL] Uh, eligibility as well.
[AGENT][POSITIVE] Yes, I can help you with both. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It is 02610088 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK, thank you, one moment while I get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Uh huh you're welcome.
[AGENT][NEUTRAL] OK, and any information that I do provide will be a verification of benefits and not a guarantee of payment. What is the patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] His name is [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show he is the 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, [PII]? inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient physical therapy?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $3000 with no outpatient deductible per covered person per calendar year.
[AGENT][NEGATIVE] And as of now, he has not used any of the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Now, because this is a supplemental policy, you're welcome because it is a supplemental policy when the claim is filed with us, we must have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then once we have processed the claim here we do have a portal in which you should be able to check claim status in and that website for our portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Well, is there anything that else?
[CUSTOMER][POSITIVE] OK. Thank you so much for your help.
[AGENT][POSITIVE] You're certainly welcome. Can I help you with anything else today?
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you so much.
[AGENT][POSITIVE] OK, well, thank you again for calling APL and I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] You too. Take care.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye, bye.