AccountId: 011433970860
ContactId: adbf754b-32de-41be-8c4c-297066b461ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292040 ms
Total Talk Time (AGENT): 147669 ms
Total Talk Time (CUSTOMER): 71977 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/adbf754b-32de-41be-8c4c-297066b461ee_20250305T16:21_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] Yes, good morning [PII]. I'm calling to verify the member's active with the insurance, please.
[AGENT][NEUTRAL] OK, so you're only needing to verify eligibility. You do not need benefits, is that correct?
[CUSTOMER][NEUTRAL] Mm, I would need both please.
[AGENT][NEUTRAL] So you do need both, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] You're speaking with [PII].
[AGENT][POSITIVE] Thank you and [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, Sydney.
[CUSTOMER][NEUTRAL] I have.
[CUSTOMER][NEUTRAL] Uh hm I have OK inpatient hospital benefits OK 01569861.
[CUSTOMER][NEUTRAL] Letters ML 7.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[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 date of birth?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oasio.
[CUSTOMER][NEUTRAL] [PII] 62873.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that he is the subscribe, excuse me, the spouse of the subscriber on the supplemental policy, Sydney, and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's gonna be for inpatient please.
[AGENT][NEUTRAL] OK one moment.
[CUSTOMER][NEUTRAL] Mhm and then are we in network with this numbers plan?
[AGENT][NEUTRAL] This is a supplemental policy to their primary insurance company only, so there is no network without with APO.
[CUSTOMER][POSITIVE] Thank you, that's one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the inpatient benefit maximum per calendar year per covered person is $5000.
[AGENT][NEUTRAL] And there is no in-hospital deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, out of pocket.
[AGENT][NEUTRAL] This is the benefit maximum. Mhm.
[CUSTOMER][NEUTRAL] And then is authorized.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] That is the benefit maximum for an inpatient admission on the supplemental policy.
[CUSTOMER][POSITIVE] Thank you Maximum, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And have they reached their maximum or?
[CUSTOMER][NEUTRAL] Or something, I guess.
[AGENT][NEUTRAL] And this is for this calendar year that you're inquiring on?
[CUSTOMER][NEUTRAL] Please, yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And as of now, no ma'am, there have not been any benefits used on the inpatient benefits. Now because this is a supplemental policy, [PII], you're welcome to the primary insurance when the claim is submitted to APL for review, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then once we have processed our claim here we do have a portal in which you should be able to check our claim status by going to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK perfect and then what about authorization?
[AGENT][NEUTRAL] Again, this, no, ma'am, not on the supplemental policy, it would not, no, ma'am.
[CUSTOMER][NEUTRAL] Would that be required?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No off required. OK, perfect. And then [PII], what is your last name initial please?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] S and yours?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and again, mine[PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And you would use my name along with today's date as your call reference number.
[CUSTOMER][POSITIVE] Awesome thank you so much for your time.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that is all then that I could help you with, [PII], thank you again for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Same to you thank you bye bye.
[AGENT][POSITIVE] Uh, yes, ma'am. Thank you. Bye-bye.