AccountId: 011433970860
ContactId: a7aca252-b0a0-48d2-a45e-b9a6d2d27fe1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240809 ms
Total Talk Time (AGENT): 96828 ms
Total Talk Time (CUSTOMER): 81756 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/a7aca252-b0a0-48d2-a45e-b9a6d2d27fe1_20250205T15:38_UTC.wav
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[CUSTOMER][NEUTRAL] So this is still the same.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from the outpatient center of Delray. I'm trying to find out the benefit information for this patient.
[AGENT][NEUTRAL] OK, [PII], so you're needing outpatient benefit information and not eligibility, just the outpatient benefits?
[CUSTOMER][NEUTRAL] Yes, uh huh.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number to you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, I'm looking at her card, it says 02585109.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And any information to you that I provide would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] It's for Rosemary Antonucci Polo hyphen Polo.
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. Just one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] What I don't know what to say. I'm gonna make copies. Do you need anything?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Yeah, you were off yesterday. What what's the problem?
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum of $2000 for covered outpatient services.
[CUSTOMER][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] With no outpatient deductible per covered person.
[AGENT][NEUTRAL] And when
[CUSTOMER][NEUTRAL] And um I did go ahead.
[AGENT][NEUTRAL] I'm sorry. No, ma'am, you go ahead first.
[CUSTOMER][NEUTRAL] Uh, is there accumulations like does she have?
[AGENT][NEUTRAL] As of now, no, ma'am.
[CUSTOMER][NEUTRAL] Anything applied to?
[CUSTOMER][NEUTRAL] No, no, no applied so.
[AGENT][NEUTRAL] So, I've not been in
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, all right, so.
[AGENT][NEUTRAL] And because this is a supplemental policy to her primary insurance, when the claim is submitted to APLTF for review, we must also have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so EOB, OK.
[AGENT][NEUTRAL] As well and uh from primary insurance and then once the claim has been processed with APO then we also have a portal that claim status can be checked in by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] All right, and do you have a reference number?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect thank you so much I appreciate your time.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome and if that's all I can help you with, thank you again for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too have a good one bye bye.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.