AccountId: 011433970860
ContactId: b6fac5b9-1c56-4ec0-908a-4311e27a7fb8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259140 ms
Total Talk Time (AGENT): 144415 ms
Total Talk Time (CUSTOMER): 76627 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/b6fac5b9-1c56-4ec0-908a-4311e27a7fb8_20250108T18:18_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] from Doctors Hospital. I'm calling to verify, I'm sorry.
[CUSTOMER][NEUTRAL] I'm calling to verify benefits and eligibility on a patient for surgery.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify benefits and eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Um, callback number [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] Policy number 02575606ML8.
[AGENT][NEUTRAL] 25, excuse me, 02575606 was the was the first part of the number. Is that correct?
[CUSTOMER][POSITIVE] Mhm, correct, yes, you got it mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And will this be, are you gonna be needing inpatient, outpatient or office benefits for this number?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, [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 their date of birth?
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEGATIVE] You sound a little tired today.
[CUSTOMER][NEUTRAL] Listen, oh my goodness. I'm fighting for my life for me.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh bless you. I, I, I, I've been like that recently, so I totally understand that feeling.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] OK, so she is the subscriber on the supplemental policy, and this supplemental policy is active with an effective date of [PII], excuse me, [PII]. Let's try that again. The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And her outpatient benefit maximum for covered outpatient services is $1000 per.
[AGENT][NEUTRAL] Under day.
[AGENT][NEUTRAL] And there is no patient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] So it's $1000 per calendar day?
[AGENT][NEUTRAL] Per calendar day, yes, ma'am, for covered outpatient services with no deductible.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And when the claim, um, when the claim is submitted with APL for review, we do also have to have a copy of the primary insurance company's explanation of benefits as well. And then you may already have this information. Do you have our portal information, [PII]?
[CUSTOMER][NEUTRAL] OK. All right. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Where you can check claim status with APL. OK, so we do have a portal.
[CUSTOMER][NEUTRAL] Mm, I don't know.
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][POSITIVE] And that website that you would go to to set the profile up for you is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have that here.
[CUSTOMER][POSITIVE] OK, thank you so much. Is there any, is there a reference number or anything or just your name?
[AGENT][NEUTRAL] OK. All right, well.
[AGENT][NEUTRAL] Sure, you would just use my name along with today's date. Yes, ma'am.
[CUSTOMER][POSITIVE] Awesome. OK, thank you so much. I appreciate it.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome and thank you again for calling APL. I hope you have a great afternoon and get you some rest.
[CUSTOMER][POSITIVE] No, thank you. Um thank you. Bye-bye.
[AGENT][NEUTRAL] OK. All right, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, bye.