AccountId: 011433970860
ContactId: b02dfeeb-d339-486e-9d29-53c96d73017c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254949 ms
Total Talk Time (AGENT): 136305 ms
Total Talk Time (CUSTOMER): 56518 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/b02dfeeb-d339-486e-9d29-53c96d73017c_20250113T15:38_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] Hi [PII], I'm a provider calling to check benefits and eligibility for a patient please.
[AGENT][NEUTRAL] OK, you're needing benefit and benefits rather an eligibility for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Is it [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, [PII]. Thank you. And your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] The member policy number is going to be 02166999 M as in Mary, L as in Larry, number 8.
[AGENT][POSITIVE] OK, thank you very much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do show that he is a subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him, [PII] in inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient ambulatory surgical center facility.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so for his outpatient benefit maximum that will be $6300 per cover person per calendar year.
[AGENT][NEUTRAL] For covered outpatient services and there is no outpatient deductible for covered person per calendar year.
[CUSTOMER][NEUTRAL] Still available?
[AGENT][NEUTRAL] For this calendar year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I can check that for you one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] As of now, yes, ma'am. I do not see that any benefits have been used for this calendar year.
[CUSTOMER][NEUTRAL] So you told me $6300 right?
[AGENT][NEUTRAL] Yes ma'am, that is the benefit max for covered outpatient services.
[CUSTOMER][POSITIVE] Perfect. Can I have reference? Thank you. Can I have reference number for the call, [PII]?
[AGENT][NEUTRAL] Her calendar year. Yes, ma'am.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes ma'am, you will actually use my name and today's date, [PII] as your call reference number and just a couple of additional things um for you to know as well because this is a supplement to his primary insurance, we will also have to have a copy of his primary insurances explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then you may already be aware of our portal, but we do have a portal in which our claim status can be checked as well as have access to the EOB for APL.
[AGENT][POSITIVE] And that portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect, thank you for the information.
[AGENT][POSITIVE] Well, you are certainly very welcome. And again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that is gonna be it. Thank you.
[AGENT][POSITIVE] You're very welcome. Have a wonderful day and thank you again for calling APL.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Mhm. Thank you. Bye-bye.