AccountId: 011433970860
ContactId: a03e0684-d2f7-454c-a0e5-1c2cd70d2bf4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 208630 ms
Total Talk Time (AGENT): 117467 ms
Total Talk Time (CUSTOMER): 40632 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/a03e0684-d2f7-454c-a0e5-1c2cd70d2bf4_20250411T19:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII], calling for benefits for a patient.
[AGENT][NEUTRAL] OK. You're needing to get benefits only, or do you also need eligibility?
[CUSTOMER][NEUTRAL] Uh, just benefits, yes, to see if they still eligible.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, so you do need both? Yes, ma'am, I can help you.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII] for my last name.
[AGENT][NEUTRAL] All right, [PII], thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 01997051.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] And [PII], any excuse me, any 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 date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show she is the subscriber on the 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 inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient, outpatient DEXA scan?
[CUSTOMER][NEUTRAL] A diagnostic test.
[AGENT][NEUTRAL] So hard, OK.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum.
[AGENT][NEUTRAL] For calendar year is $7000.
[AGENT][NEUTRAL] For covered outpatient services and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And because this is a supplement, [PII] to her primary insurance, we will also have to have a copy of her primary insurance's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which you should be able to check claim status for her and that portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEGATIVE] And as of now she has not used any benefits for this calendar year.
[CUSTOMER][NEUTRAL] OK. Is there a rough number for I'm sorry?
[CUSTOMER][NEUTRAL] OK, is there a rough enough for the phone call, Ms. [PII]?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date and the first initial to my last name if you need that is [PII].
[CUSTOMER][POSITIVE] Thank you so much, Ms. [PII].
[AGENT][POSITIVE] Well, you're very welcome. And again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK, well thank you for calling APO and I hope you have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.