AccountId: 011433970860
ContactId: a18987ac-46af-41a5-85c9-56519a16101b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263140 ms
Total Talk Time (AGENT): 151701 ms
Total Talk Time (CUSTOMER): 66341 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=3.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/a18987ac-46af-41a5-85c9-56519a16101b_20250219T16:09_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] Good morning, [PII]. My name is [PII] and I wanna verify benefits for a patient on a surgery with us tomorrow, please.
[AGENT][NEUTRAL] OK. You said your name is [PII]. Is that correct?
[CUSTOMER][POSITIVE] It is correct.
[AGENT][NEUTRAL] OK, yes, ma'am and you're needing to verify benefits and eligibility for a member, is that correct, [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes, I can help you with both things and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] 025128.
[CUSTOMER][NEUTRAL] 93
[CUSTOMER][NEUTRAL] M for Mary, L for Larry, number 8.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I provide would be a verification of benefits and not a guarantee of payment. Uh, let's see, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. And the date of birth, if you give me one quick second, let me open my next screen is
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. I must have.
[AGENT][NEUTRAL] I may have heard your, OK, just one moment. I keyed in a one wrong digit and I was like, wait, I don't think that's correct. So, OK, one second. All right, go ahead. What is her date of birth again, please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you, [PII], one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I do show that Ms. [PII] is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And again, uh, are you needing outpatient benefits, is that correct? OK.
[CUSTOMER][POSITIVE] Yes, please. Mhm. Yes, please.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max of $1500 per calendar day for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][POSITIVE] OK, perfect. And would you please check if she hasn't used anything this year because it's exactly what she owes as a co-pay for.
[AGENT][NEUTRAL] Because this is so.
[AGENT][NEUTRAL] Again.
[AGENT][NEUTRAL] This is a per calendar day. And you said your surgery has not occurred yet.
[CUSTOMER][NEUTRAL] Oh, per calendar day.
[AGENT][NEUTRAL] Yes ma'am, it's not a per calendar year benefit, it's a per calendar day.
[CUSTOMER][POSITIVE] Oh, then we're good.
[AGENT][NEUTRAL] And because this policy is a supplemental policy, [PII], when the claim is submitted to APO we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][POSITIVE] Perfect. We'll have everything ready for you.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] OK, and one last thing, once we have processed our claim here at APL, we do have a portal in which you should be able to check claim status and have access to our EOB and our portal website is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK. And is there any?
[CUSTOMER][POSITIVE] Oh, all [PII]. Thank you. Um.
[AGENT][NEUTRAL] Uh, go ahead.
[CUSTOMER][NEUTRAL] Um, I was just gonna ask you for a reference number for our call, please, if possible.
[AGENT][POSITIVE] Yes, ma'am. You will actually use my name along with today's date.
[CUSTOMER][NEUTRAL] And I'm sorry, what was your name once again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much for your help today, [PII]. Have a wonderful afternoon.
[AGENT][POSITIVE] Well, you're welcome, [PII]. Yes, ma'am. I hope you do too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Goodbye.