AccountId: 011433970860
ContactId: a485303a-cad6-409d-9cea-77a2030a06f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258260 ms
Total Talk Time (AGENT): 120416 ms
Total Talk Time (CUSTOMER): 78674 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/a485303a-cad6-409d-9cea-77a2030a06f0_20250521T14:09_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] Hi, how are you? My name is [PII]. I'm calling to check eligibility for a patient.
[AGENT][NEUTRAL] OK, [PII], you're needing to check eligibility for a number, is that correct?
[CUSTOMER][NEUTRAL] I'm sorry, I couldn't
[AGENT][NEUTRAL] Did you say that you were needing to check eligibility for a member?
[CUSTOMER][NEUTRAL] I miss, I miss
[CUSTOMER][NEUTRAL] Oh, yes, sorry.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, it's gonna be.
[CUSTOMER][NEUTRAL] 02450103 ML 8.
[AGENT][NEUTRAL] OK, thank you, [PII], one moment please.
[AGENT][NEUTRAL] And any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] OK, thank you
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and I do show that he is a dependent on the supplemental policy, [PII]. This policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And if you all will be filing a claim with us for him, we will also have to have a copy of his primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then once the claim has been processed here at [PII], we do have a portal that you should be able to check his claim status in and the website for that portal is located at [PII].
[CUSTOMER][NEUTRAL] An appointment
[CUSTOMER][NEUTRAL] OK, a [PII].
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] The patient has any max amount for the hospital outpatient?
[AGENT][NEUTRAL] Oh, you're needing benefits as well as eligibility?
[CUSTOMER][NEUTRAL] Outpatient
[CUSTOMER][NEUTRAL] Yes, I'm calling for eligibility.
[CUSTOMER][NEUTRAL] See you.
[AGENT][NEUTRAL] OK. Yes, ma'am. I gave you eligibility. Do you also need benefit information?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, because the patient is here is having a service of X-ray. I would like to know if it's uh active and I have to put that on the patient's X-ray that is everything is active and.
[AGENT][NEUTRAL] OK, the policy is active and the outpatient benefit maximum per calendar day for covered outpatient services is $750 with no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK. And uh can I have a reference number from this call, please?
[AGENT][NEUTRAL] Yes, ma'am. It would be my name along with today's date.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][POSITIVE] Thank you. OK, thank you so much.
[AGENT][POSITIVE] OK. Well, you're very welcome.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome. Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that's all. Thank you. Have a great day.
[AGENT][POSITIVE] Uh, I hope you have a great day too, [PII], and thank you again for calling APL. Yes, ma'am, you too.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Bye thanks bye.
[AGENT][NEUTRAL] Bye bye.