AccountId: 011433970860
ContactId: a40fa130-9804-4c47-b5cf-cc107f09a5bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231949 ms
Total Talk Time (AGENT): 124355 ms
Total Talk Time (CUSTOMER): 47936 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/a40fa130-9804-4c47-b5cf-cc107f09a5bb_20250210T18:31_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] Yes, hi [PII], my name is [PII] with Memorial Herman Hospital, and I'm trying to get outpatient hospital benefits on a patient, please.
[AGENT][NEUTRAL] OK, [PII], so you're needing outpatient benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am. The office visit and a screening mammogram.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] I have 02573163.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And [PII], 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 and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I see that she is the subscriber's spouse.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this supplemental policy is active, effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get her benefit information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so now on this supplemental policy, office visits are not covered.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] They're not covered. What about a mammogram?
[AGENT][NEUTRAL] Office visits or?
[AGENT][NEUTRAL] If it's done in the office setting, no, ma'am, or is it gonna be done at an outpatient facility?
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum for covered out excuse me, the outpatient benefit maximum per covered person for covered outpatient services, [PII] is $1000 per year with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Deductible. Is there a PPO network?
[AGENT][NEUTRAL] This is a supplemental policy, so it follows her primary.
[AGENT][NEUTRAL] So there's no network or prior authorization required with APL and when you do submit the claim to us for review, we must have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL, [PII], we do have a portal in which you should be able to take claim status and have access to our EOB.
[AGENT][POSITIVE] And our portal website is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Now, is there gonna be a call reference number for this call, [PII]?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so very much. I appreciate that and you have a good day.
[AGENT][POSITIVE] Well, oh, well, thank you so much. I hope you have a great afternoon as well, and if that's all I can help you with, thank you again for calling APL today, [PII].
[CUSTOMER][NEUTRAL] OK. Bye-bye.
[AGENT][NEUTRAL] All right, bye bye.