AccountId: 011433970860
ContactId: a090ceec-ef4e-456f-a41d-ce5a6dbd3ef3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330190 ms
Total Talk Time (AGENT): 160486 ms
Total Talk Time (CUSTOMER): 114350 ms
Interruptions: 4
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/a090ceec-ef4e-456f-a41d-ce5a6dbd3ef3_20250409T12:36_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 morning. My name is [PII]. I'm calling you from Pembroke Pink Imaging checking to see if a patient is active and the maximum amount that she has.
[AGENT][NEUTRAL] OK, so I do you're wanting to check eligibility and also to see what the calendar your benefit is or the calendar day, whichever it is on our plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with those things. And [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 01704612M as in Mary L as in Louis 8.
[AGENT][POSITIVE] OK, thank you. I give me just a couple of moments please to get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information Al that 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] OK.
[CUSTOMER][NEUTRAL] Her name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show she is a dependent on the supplemental policy, I uh, and this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Out outpatient, outpatient, it's gonna be done in the office without an office visit charge.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so procedures done in the office and office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh-huh. No what is it? Mhm.
[AGENT][NEUTRAL] Correct, or procedures in the office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, um, so she's not gonna be covered?
[AGENT][NEUTRAL] On her supplemental policy, it does not provide benefits for office visits or treatment done within the office setting.
[CUSTOMER][NEUTRAL] Like a diagnostic center, outpatient, she's not covered? Nothing?
[AGENT][NEUTRAL] OK, so is it a diagnostic center or an office? Cause you had originally said an office setting.
[CUSTOMER][NEUTRAL] It's a breast, uh-huh. It's a like.
[CUSTOMER][NEUTRAL] It, it is a diagnostic center outpatient for a breast ultra.
[AGENT][NEUTRAL] OK, so she has an outpatient.
[AGENT][NEUTRAL] OK, so her outpatient benefit max, her calendar year for covered outpatient services is $2500 and there is no outpatient deductible per cover person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now if you all do file a claim out with APL you will also need to send us a copy of her primary insurance company's uh explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then once we have processed.
[CUSTOMER][NEGATIVE] Right, yeah, that's the billing. I don't do.
[AGENT][NEUTRAL] OK, and once the claim has been processed, we do also have a.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Portal that you should be able to check claim status for us by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Has she met anything of the 2500 outpatients out of uh outpatient benefits?
[AGENT][POSITIVE] I can check that for you.
[AGENT][NEUTRAL] And I can check that one moment.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And as of now, no, ma'am, she has not.
[CUSTOMER][NEUTRAL] OK, very good. OK, [PII], we're all done any uh reference number for this call? Is it your name and the date today's date?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am. You, that's it. Yes, ma'am. It certainly is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you. We're done.
[AGENT][NEUTRAL] So is there anything else that I can help you with? OK.
[CUSTOMER][POSITIVE] No thank you you have a wonderful day today.
[AGENT][POSITIVE] Well, I hope you have a wonderful day as well, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Bye love bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.