AccountId: 011433970860
ContactId: a4d27146-4969-4be3-a4a6-d2abaddd936e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422600 ms
Total Talk Time (AGENT): 225145 ms
Total Talk Time (CUSTOMER): 127882 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/a4d27146-4969-4be3-a4a6-d2abaddd936e_20250618T18:51_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 [PII], good afternoon. I'm calling to verify uh this.
[CUSTOMER][NEUTRAL] Uh, insurance for a mutual member. I'm calling from I'm&A Health Queen of the Valley Hospital.
[CUSTOMER][NEUTRAL] I have this as her secondary insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and benefits or just eligibility?
[CUSTOMER][POSITIVE] Correct, just eligibility. Oh, you know, I'll take eligibility and benefits actually. I'll take both, please.
[AGENT][NEUTRAL] OK, yes, ma'am.
[AGENT][NEUTRAL] OK, yes, well I can help you with both and who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] OK, thank you and [PII], what's a good call back number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] Number I have on file is 251-945-7.
[AGENT][NEUTRAL] OK, thank you. One moment while I.
[CUSTOMER][NEUTRAL] 251-9457
[AGENT][POSITIVE] OK, thank you, give me a moment please to get the member's information pulled up. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[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 their date of birth? Uh huh, sure.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that she is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's for medical outpatient, it's outpatient or outpatient occupational therapy.
[AGENT][NEUTRAL] Outpatient, OK.
[AGENT][NEUTRAL] OK, give me just a moment to look at a couple of things.
[CUSTOMER][POSITIVE] Thank you, no problem.
[AGENT][NEUTRAL] Uh, certainly.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This patient I already worked on her.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Look
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services, Angie, is $4050 with no outpatient deductible.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Actually, give me just a moment and I'm not sure, no.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hold on one second. I need to look at something before I said I may have to change what I just said to you just a second.
[CUSTOMER][POSITIVE] Sure, no problem.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Not a problem thank you.
[AGENT][NEUTRAL] OK, I'm so sorry that was the inpatient benefit. The outpatient benefit max I'm sorry, was it $2,025 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $2,025. This is her out of pocket max.
[AGENT][NEUTRAL] That is her out that is the maximum benefit on this policy for covered outpatient service.
[CUSTOMER][NEUTRAL] So it's 2025.
[AGENT][NEUTRAL] Correct. And as of now, she has not used any of these benefits as of now.
[CUSTOMER][NEUTRAL] Per year, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, because this is a supplement to her primary insurance, just a couple of additional things, [PII], you need to know. Um, we will have to have a copy of her primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That's copy of XOB. Uh huh.
[AGENT][NEUTRAL] Mhm. And make sure that it's a detailed copy and when I say that, that it shows any amounts applied to the deductible co-pay or co-insurance because that's what this plan. Mhm.
[CUSTOMER][NEUTRAL] Like an explanation, a detailed an itemized bill.
[AGENT][NEUTRAL] Well, it's just some of the explanation of benefits now don't have, it's, they're not showing amounts applied to the deductible, co-pay or co-insurance, and those are the three categories that this plan is designed to help with. So we do have to have, you know, that information.
[CUSTOMER][NEUTRAL] Detailed
[CUSTOMER][NEUTRAL] With claim name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When reviewing a claim.
[CUSTOMER][NEUTRAL] Medicare supplement.
[AGENT][NEUTRAL] But this is not a, this is not a Medicare supplement, OK? This plan is not, this is a supplement to her pri uh excuse me, her primary.
[CUSTOMER][NEUTRAL] All right, I'll document that.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Health care insurance which we show that to be as health Easy.
[CUSTOMER][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm storage.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Healthcare.
[AGENT][NEUTRAL] Uh huh, this is a supplement to that and then lastly, once we've reviewed and processed a claim, we have a portal that you should be able to check claim status in.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the website for our portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] [PII], uh huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Secured. [PII].
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Can I help you with anything else today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh, yes, yeah, I believe I have everything I need. Uh, do you mind if I get your name once again and a reference number?
[AGENT][NEUTRAL] Yes, and actually my name in today's date will be your call reference number, [PII], and it, again, my name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII]. All right, well thank you so much, [PII].
[AGENT][POSITIVE] OK, well, you're very welcome and thank you for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][POSITIVE] Thank you mhm bye bye.
[AGENT][NEUTRAL] Uh-huh.