AccountId: 011433970860
ContactId: b4917561-ce5a-41ec-9da7-8c46bd5c7ff8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 199940 ms
Total Talk Time (AGENT): 100326 ms
Total Talk Time (CUSTOMER): 37450 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/b4917561-ce5a-41ec-9da7-8c46bd5c7ff8_20250206T21:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling to obtain benefits for a member.
[AGENT][NEUTRAL] OK, you're needing benefits only. You do not need eligibility?
[CUSTOMER][NEUTRAL] Um, yes, sorry, eligibility as well.
[AGENT][POSITIVE] OK, yes ma'am. I can help you with both and who am I speaking with please?
[CUSTOMER][NEUTRAL] With [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] It is 02503115.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And any information [PII] 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 their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is a subscriber on the supplemental policy.
[AGENT][NEUTRAL] And the supplemental policy is active, [PII], with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] For outpatient.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] So he has an outpatient benefit maximum per calendar day for covered outpatient services of $1000.
[AGENT][NEUTRAL] With no outpatient deductible per cover person per calendar day.
[AGENT][NEUTRAL] Because this is a supplemental policy, [PII], to his primary insurance, we must also receive a copy of his primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And once we have processed our claim, we do have a portal that you should be able to check claim status in and have access to our EOB and the website for that is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, perfect. All righty. So it's um covers up to $1000 per calendar day for outpatient services.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, perfect. And [PII], can I get a call reference number?
[AGENT][POSITIVE] Yes ma'am, you will actually use my name along with today's date.
[CUSTOMER][POSITIVE] OK, perfect. Thank you for your help.
[AGENT][POSITIVE] You're certainly very welcome. And if that's all then that I can help you with, thank you again for calling APL [PII] and I hope you have a very nice evening.
[CUSTOMER][POSITIVE] Thank you you too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.