AccountId: 011433970860
ContactId: aadb16a7-cc36-4314-872b-6d558f4ce04a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280920 ms
Total Talk Time (AGENT): 144309 ms
Total Talk Time (CUSTOMER): 60113 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/aadb16a7-cc36-4314-872b-6d558f4ce04a_20250403T12:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. Can I help you?
[CUSTOMER][NEUTRAL] Hi, I just wanna verify this patient out uh patient benefits. They're coming in for a procedure with our facility tomorrow.
[AGENT][NEUTRAL] OK, you're needing to verify eligibility and benefit benefits.
[CUSTOMER][NEUTRAL] My name is [PII] which is [PII].
[AGENT][NEUTRAL] OK, and [PII], did you say that you're needing by eligibility and benefits or only benefits?
[CUSTOMER][NEUTRAL] Um, just making sure that you guys are gonna be picking up her primary co-payment.
[AGENT][NEUTRAL] I can help you with benefit information lately, and what is your callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] I have it as 02465595 ML 8.
[AGENT][NEUTRAL] OK, thank you, give me a moment please to get the member's information pulled up.
[AGENT][NEUTRAL] OK [PII], I do need to verify several things with you first for security purposes and all.
[AGENT][NEUTRAL] So any information that is provided would be a patient of benefits and not a guarantee of payment. So first off, what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] What was this [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So first off, [PII], the policy, I need to give you an updated policy number because the policy number that you provided for me.
[AGENT][NEUTRAL] Uh, give me just a moment to look at something.
[CUSTOMER][NEUTRAL] So big.
[AGENT][NEUTRAL] OK, so the that is an incorrect policy number for this number?
[AGENT][NEUTRAL] Her current policy number is 01659744.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is active with an effective date of [PII].
[AGENT][NEUTRAL] And again you said that you were needing outpatient benefits for this member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, she has an outpatient benefit maximum per calendar year for covered outpatient services of $7900 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Because this is a supplemental.
[CUSTOMER][POSITIVE] Perfect. And when
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Uh, OK, so because this is a supplemental policy lately to her primary insurance, when the claim is submitted to APL for review, we will also have to have the a copy of her primary.
[AGENT][NEUTRAL] Insurance company's explanation of benefits as.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] And then once we have processed the claim here at APO we.
[AGENT][NEUTRAL] You have a portal that you should be able to check claim t and our portal website is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Appreciate your help. What is your name?
[AGENT][NEUTRAL] Again, my name is [PII] and you will use my name in today's date if you need a call reference number.
[AGENT][NEUTRAL] So is there anything else, [PII]? Yes, ma'am. You too. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you. You have a good day.
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK, well thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mm