AccountId: 011433970860
ContactId: aa49b846-6b0e-4e60-8fd6-7980e969d2da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238660 ms
Total Talk Time (AGENT): 119243 ms
Total Talk Time (CUSTOMER): 59325 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/aa49b846-6b0e-4e60-8fd6-7980e969d2da_20250313T15:00_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning [PII]. My name is [PII]. I'm trying to verify, um, patients eligibility and benefits. I'm calling from the facility.
[AGENT][NEUTRAL] OK, [PII], you're needing.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify benefits and eligibility for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] It is 02477145.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Oh, I'm very sorry about that, [PII].
[CUSTOMER][POSITIVE] No worries.
[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?
[CUSTOMER][NEUTRAL] Uh, it is [PII] date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I do say she is the subscriber on the supplemental policy and this policy is active. What's an effective date of [PII]?
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] Setting.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum of $7000 per calendar year for covered outpatient services, and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Now if you all
[CUSTOMER][NEUTRAL] How much did the uh the patient say that he has?
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] Oh, as of now for this calendar year, there have not been any benefits used.
[CUSTOMER][NEUTRAL] I'm sorry, um, does the patient has, um, the
[CUSTOMER][NEUTRAL] It's covered for outpatient.
[AGENT][NEUTRAL] Again, I gave you the outpatient benefit max for covered outpatient services, which is $7000.
[CUSTOMER][NEUTRAL] Yeah, but I didn't hear you. That's OK, 7000 or 7?
[AGENT][NEUTRAL] Yes, ma'am, 7000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And as of now, there have not been any benefit used.
[CUSTOMER][NEUTRAL] Does the patient have been used?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if this claim will be filed with APL you will also excuse me, you will also need to send us a copy of the primary explanation of benefits as well.
[AGENT][NEUTRAL] And then once the claim has been processed by APO we do have a portalin in which you can check claim status by going to secured. [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, perfect. Do I have any call reference number for the call?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] What what's your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, thank you, [PII].
[AGENT][POSITIVE] Well, you're very welcome. And is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that'll be it thank you.
[AGENT][POSITIVE] OK, well then, thank you again for calling APO and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you, same. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you.