AccountId: 011433970860
ContactId: ba82f73e-850b-4e99-a02d-75245402216b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290859 ms
Total Talk Time (AGENT): 144200 ms
Total Talk Time (CUSTOMER): 67447 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=2.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/ba82f73e-850b-4e99-a02d-75245402216b_20250521T13:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a facility, the University of Miami. Um, I just wanted to verify some coverage for a patient.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and benefits or just one or the other, [PII]?
[CUSTOMER][POSITIVE] Um, if I, if I could do both, that would be great thank you.
[AGENT][POSITIVE] Yes, I can help you with both. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Uh, that would be [PII] and that's a direct line.
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Yes, let's see here the.
[CUSTOMER][NEUTRAL] Member number that I have here is 02497677 M as in Mike L for Lima, the number 7 again.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] This is for Mr. [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I need to give you a different policy number for him, [PII] that policy was, uh, it has an effective date and a term date of the same date, so it was like it was never really issued. The correct policy number that you should have for him is 02405433.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And again, any information that I provide today will be a verification of benefits and not a guarantee of payment, but this supplemental policy is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With an effective date of [PII].
[AGENT][NEUTRAL] And give me one moment while some other information is pulling up for me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for Mr. [PII], are you needing inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] Uh, outpatient benefits, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $7900 and there is no outpatient deductible per cover person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy, [PII] to his primary insurance, when the claim is filed with us, we will also have to have a copy of his primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim here, we do have a portal in which you should be able to check our claim status and that website is located at [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then um you said so the max max yearly occupation benefit was 7900, right?
[AGENT][POSITIVE] That is correct. Yes, sir.
[AGENT][NEGATIVE] And as of now, no benefits have been used.
[CUSTOMER][POSITIVE] Perfect. By any chance, does it show you?
[CUSTOMER][POSITIVE] Oh, perfect, you read my mind.
[CUSTOMER][POSITIVE] Thank you so much. That'll be, um, that'll be everything I need. Uh, are you able to provide me a reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, you would use my name that I had given you along with today's date.
[CUSTOMER][POSITIVE] All right, perfect. Well, thank you again, [PII]. Have a nice day.
[AGENT][POSITIVE] Well, you, I hope you have a wonderful day too, [PII], and thank you again for calling APL if that's all I can help you with.
[CUSTOMER][NEUTRAL] Mhm, that'll be all bye bye.
[AGENT][NEUTRAL] OK, bye-bye