AccountId: 011433970860
ContactId: b1a49e34-26bf-42e4-85ca-dd74247a6777
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 186419 ms
Total Talk Time (AGENT): 97532 ms
Total Talk Time (CUSTOMER): 39958 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/b1a49e34-26bf-42e4-85ca-dd74247a6777_20250516T17:51_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Afternoon, thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, my name is [PII]. I was calling to get outpatient benefits for patients.
[AGENT][NEUTRAL] OK, [PII], you're needing outpatient benefits for a member, is that correct? But you do not need eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, I would need to know she's active as well.
[AGENT][POSITIVE] OK, so I can help you with both and what is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK, thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 01790839.
[AGENT][NEUTRAL] OK thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I do provide for you [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you. So I do show she's a subscriber on the supplemental policy. It is active with an effective date of [PII].
[AGENT][NEUTRAL] And she has an outpatient benefit maximum per calendar year for covered outpatient services of $2500 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Alright, and has she used any of her for this year?
[AGENT][NEUTRAL] I can check.
[AGENT][NEUTRAL] As of now, no, ma'am, she has not.
[AGENT][NEUTRAL] And when the claim is submitted Leah to APL for review, we will have to have a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][POSITIVE] Alright, perfect.
[AGENT][NEUTRAL] And then once uh the claim has been processed here at APL we do have a portal that you should be able to check our claim status in.
[AGENT][NEUTRAL] If you go to [PII].
[CUSTOMER][POSITIVE] OK, yeah, billing already has that info, but thank you for your help, OK.
[AGENT][POSITIVE] OK. Well, you're very welcome. Can I help you with anything else?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] No, no, just for this one account.
[AGENT][POSITIVE] OK, well then, thank you for calling APL and I hope you have a nice weekend.
[CUSTOMER][POSITIVE] Thank you, you too, [PII] bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye.