AccountId: 011433970860
ContactId: a73e28f5-4d16-4d98-bed1-0d651b6b9a7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228899 ms
Total Talk Time (AGENT): 117242 ms
Total Talk Time (CUSTOMER): 50412 ms
Interruptions: 1
Overall Sentiment: AGENT=2.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/a73e28f5-4d16-4d98-bed1-0d651b6b9a7d_20250501T12:47_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, I am needing to get eligibility and benefits for a patient please.
[AGENT][NEUTRAL] OK, you have one patient that you're needing eligibility and benefits for, is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, that's correct.
[AGENT][POSITIVE] Yes ma'am. I can help you with that, and who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] That is 02137727.
[AGENT][NEUTRAL] OK, [PII], give me just a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I see any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] This is for [PII]. The date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One second, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] M
[AGENT][NEUTRAL] OK, so I do show that she is the spouse of the subscriber on the supplemental policy and the policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for her today inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] to do that.
[CUSTOMER][NEUTRAL] This is going to be for outpatient physical therapy in a hospital setting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum per calendar day for covered outpatient services of $500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because this is a supplemental policy, [PII] to her primary insurance, when the claim is submitted to us for review, we must also receive a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah you were
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which you should be able to check claim status for us and the website for our portal is located at secured.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right well thank you.
[AGENT][POSITIVE] All right. Well, you're certainly welcome. Is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] That should be it.
[AGENT][POSITIVE] OK, well then, thank you again, [PII], for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Bye.