AccountId: 011433970860
ContactId: ae338a0b-35d3-4809-9072-e86cbc9e9f60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272760 ms
Total Talk Time (AGENT): 140812 ms
Total Talk Time (CUSTOMER): 59242 ms
Interruptions: 1
Overall Sentiment: AGENT=2.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/ae338a0b-35d3-4809-9072-e86cbc9e9f60_20250604T19:27_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was just wondering if I can get some benefits and eligibility for a patient.
[AGENT][NEUTRAL] OK, you have one patient that you're needing eligibility and benefit information for, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII] and I'm calling from Baptist Hospital.
[AGENT][POSITIVE] Thank you. And [PII], um, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Yes, callback number would be [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number that you're calling about?
[CUSTOMER][NEUTRAL] Yes, it would be 112.
[CUSTOMER][NEUTRAL] 952 1.
[AGENT][NEUTRAL] OK, thank you, [PII]. One moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it would be [PII] is the first name. Last name is [PII], and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so the policy number that you provided for me is an old policy. I mean, that policy is no longer active. It actually termed as a 112025. There is another policy that is active with a different number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the correct policy number that you should have is going to be 02587241.
[AGENT][NEUTRAL] And this policy has an effective date of [PII].
[AGENT][NEUTRAL] And give me a moment to get that information pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and what type of benefits she is, I mean, she is covered on this new policy also, what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] So it would be outpatient for the urgent care. I just wanted to know if the co-pay was covered.
[AGENT][NEUTRAL] OK, so on again, any information that I provide for you would be a verification of benefits and not a guarantee of payment. So on this supplemental policy, there is an outpatient benefit max per calendar year for covered outpatient services of $5000.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And there's no deductible.
[AGENT][NEUTRAL] Per calendar year per covered person. Now, when the claim is submitted to us for review, [PII], we will have to have a copy of the primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal that you should be able to check claim status in and the website for that is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII] perfect.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Thank you, [PII]. And then may I have a
[AGENT][POSITIVE] Well, you're welcome.
[CUSTOMER][NEUTRAL] May I have a reference number for this call?
[AGENT][NEUTRAL] Oh sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] OK. Well, you're very welcome. And is there anything else, [PII] that I can help you with today?
[CUSTOMER][NEUTRAL] No, that is it.
[AGENT][POSITIVE] OK, well thank you again for calling ATL and I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] Thank you you too thanks bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.