AccountId: 011433970860
ContactId: a03a7572-5cf6-4b16-a98a-3bb66bebb2e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249130 ms
Total Talk Time (AGENT): 122465 ms
Total Talk Time (CUSTOMER): 60075 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/a03a7572-5cf6-4b16-a98a-3bb66bebb2e6_20250312T12:34_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, I just wanna uh verify a patient that um her coverage, see what her benefits are. She's having a procedure here on Thursday.
[AGENT][NEUTRAL] OK, I'm so sorry the sound went out on our call. Did you say you were needing to verify eligibility and benefits or strictly benefit information for a member?
[CUSTOMER][NEUTRAL] Um, yeah, to see if they're active and, and how much they're covered for, yes.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] This is [PII]
[AGENT][NEUTRAL] Can you spell your name for me?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK, [PII], thank you. And your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02295795 ML 8.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] And any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and [PII], and again, any information provided would be a verification of benefits and not a guarantee of payment. Yes ma'am, she is covered as a dependent 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 her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] She's outpatient in an ambulatory surgical facility.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so in this supplemental policy, the outpatient benefit max per calendar year for covered outpatient services is $3500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][POSITIVE] OK, perfect. And she has not used any of those benefits as of yet.
[AGENT][NEUTRAL] No, ma'am, as of now, she has not for this calendar year and lately when, because it is a supplemental policy out to the primary insurance, when the claim is submitted to APL for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well. And then once we have processed our claim, we have a portal that you should be able to check claim status in, and that website for the portal is secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All [PII]. I appreciate your help. What is your name?
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you, [PII]. You have a great day.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, you know, yes, ma'am, is there anything else that I can help you with first, [PII]?
[CUSTOMER][NEUTRAL] Uh, just a reference if you have one.
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] Well, you're very welcome and thank you again for calling APL. I hope you have a great day also.