AccountId: 011433970860
ContactId: b877db3e-e97d-4f2e-9158-91d6599457f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288309 ms
Total Talk Time (AGENT): 140043 ms
Total Talk Time (CUSTOMER): 76787 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/b877db3e-e97d-4f2e-9158-91d6599457f8_20250212T15:20_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, good morning, [PII]. My name is [PII], last initial [PII].
[AGENT][POSITIVE] Hi, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] I'm calling, um, I'm calling from Baptist Surgery and Endoscopy Center and I had a member come to our facility today, um, for a procedure, and she has provided us with, um, uh, a policy number. We wanna make sure if it's active and what her benefits are, um, because we spoke with someone else and they told us that the plan is inactive but she keeps insisting that her plan is active until [PII] so I wanna triple check that.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK [PII], so you're needing to verify eligibility and outpatient benefits phone number, is that correct?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And the member's policy number that you have?
[CUSTOMER][NEUTRAL] I have 02457137 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[AGENT][NEUTRAL] Just one moment, [PII].
[CUSTOMER][POSITIVE] Sure, no worries, thank you.
[AGENT][POSITIVE] Thank you uh huh thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of their date of birth?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] OK, so I do show that Ms. [PII] is the subscriber on the supplemental policy.
[AGENT][NEUTRAL] And this supplemental policy with APL is active with an effective date of [PII].
[AGENT][NEUTRAL] And she has an outpatient benefit maximum per calendar year per covered person for covered services of $2500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][POSITIVE] All right awesome
[AGENT][NEGATIVE] And you said that you had spoken to someone here that said it is not active because I don't see where we've received a call.
[CUSTOMER][NEUTRAL] Um, has she?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Related to that the AP for here at APL anyway.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] My my colleague spoke with [PII] on 25.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0 25. OK, one moment.
[CUSTOMER][NEUTRAL] Yeah, around [PII] is the time that the note came in.
[AGENT][NEUTRAL] And I'm not sure. The policy, the policy, I don't see that in, in the system for 25.
[AGENT][NEUTRAL] But I do, but this policy is active now because it is a supplemental policy, [PII], to her primary insurance, we will have to have a copy of the primary insurance company's explanation of benefits sent along with the claim for review.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which claim status can be checked and that portal website for us is [PII].
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEGATIVE] And there as of now there have not been any benefits used for this calendar year.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][POSITIVE] All right, thank you so much I appreciate your help, [PII]. May I have a reference number please?
[AGENT][NEUTRAL] For you, yes, ma'am.
[AGENT][NEUTRAL] Yes, you would use my name along with today's date and if you need the first initial to my last name it is [PII].
[CUSTOMER][POSITIVE] All right, thank you so much I appreciate your time.
[AGENT][POSITIVE] Well, you're certainly very welcome and if that is all I can help you with [PII], thank you again for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Um, thank you. Bye bye.