AccountId: 011433970860
ContactId: ad07c304-43ce-4f07-bf93-c2de2aa73c7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250270 ms
Total Talk Time (AGENT): 131739 ms
Total Talk Time (CUSTOMER): 86987 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/ad07c304-43ce-4f07-bf93-c2de2aa73c7d_20250207T21:00_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm, my name is [PII] and I'm calling from Baptis Outpatient. Can you please help me to verify for my patient, um, is going, I have a gap insurance. I want to know, um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] How much does she have to cover uh co-payment or deductible. Um, I have.
[AGENT][NEUTRAL] OK, [PII], are you needing, so you're needing to verify eligibility and outpatient benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Uh-huh, exactly.
[AGENT][POSITIVE] Yes ma'am. I can help you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's 02562964, M as in mother, L.
[CUSTOMER][NEUTRAL] And 8
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] I don't know why.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. So I do show that Ms. [PII] is the subscriber on the supplemental policy. It is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has excuse me, her outpatient benefit max, her calendar year per covered person for covered outpatient services is $1000.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so this gap insurance covers 1000.
[AGENT][NEUTRAL] That is her maximum calendar year benefit. Yes, ma'am, for covered outpatient services.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Just 1000, OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And because this is
[CUSTOMER][NEUTRAL] OK. Um, any re
[AGENT][NEUTRAL] Oh, I'm sorry. Just a couple more things, [PII], uh, because this is a supplemental policy to her primary insurance, when the claim is submitted to APL for review, we must also receive a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal the claim status can be checked and also access to the EOB for APL and our website for that is secured. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And she's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, do you have any reference number for this call or just your just your name?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] Can you, can you please spell for me your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm sorry, [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. And the first letter of your last name?
[AGENT][NEUTRAL] Yes, and yours?
[CUSTOMER][POSITIVE] Perfect. Mine is 8.
[AGENT][NEUTRAL] What
[AGENT][POSITIVE] [PII]. OK, thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you for your help, [PII].
[AGENT][POSITIVE] All right. Well, you're welcome, [PII], and if that's all I can help you with, thank you again for calling APL. I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Mm, thank you, you too. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.