AccountId: 011433970860
ContactId: bb836f0d-5a5a-4203-b5e7-5014ff2335ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332559 ms
Total Talk Time (AGENT): 155378 ms
Total Talk Time (CUSTOMER): 96034 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=2.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/bb836f0d-5a5a-4203-b5e7-5014ff2335ee_20250304T15:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling from South Miami Hospital. I wanted to see if I'm able to check for benefits for a patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], you only need benefits. You do not need eligibility as well, is that correct?
[CUSTOMER][NEUTRAL] Um, may I have eligibility as well?
[AGENT][POSITIVE] You can, I can help you with both. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Yes, it is [PII] option one.
[AGENT][NEUTRAL] Thank you. And then what is the member's policy number?
[CUSTOMER][NEUTRAL] The member's policy number is 02444.
[CUSTOMER][NEUTRAL] 488.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Of course
[AGENT][NEUTRAL] OK, and [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 date of birth?
[CUSTOMER][NEUTRAL] Thank you. The patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. So I do show here is the subscriber on the supplemental policy and it is active 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] Yes, it'll be for outpatient hospital facility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] OK, so on this supplemental policy, he has an outpatient benefit maximum per occurrence for covered outpatient services of $500.
[AGENT][NEUTRAL] With no outpatient deductible per covered person per occurrence.
[CUSTOMER][POSITIVE] Perfect. And has he met anything yet out of those 500?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] As of now, no, ma'am. We do not have, have.
[AGENT][NEUTRAL] Any claims on file for this calendar year.
[CUSTOMER][POSITIVE] Perfect, so he would have um a balance well, not a balance like a coverage amount of 500 for outpatient services.
[AGENT][NEUTRAL] Her occurrence.
[CUSTOMER][NEUTRAL] Per.
[AGENT][NEUTRAL] Yes, ma'am. Per occurrence means for the same or related condition.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Unless separated by a period of 90 days or a totally, you know, unrelated condition.
[CUSTOMER][POSITIVE] OK perfect and I have a.
[AGENT][NEUTRAL] Now, because this is a.
[AGENT][NEUTRAL] Supplemental policy to his primary insurance when the claim is submitted to APO for review. [PII], we will also have to receive a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Uh, let me see here, and I wanted to check by any chance, are you able to check, um, regarding like procedure codes?
[AGENT][NEUTRAL] No, ma'am, because again, this is a supplement to his primary insurance. It helps with co-pays, deductibles and co-insurance amounts of coverage services, so we would have to just receive the claim with the EOB for review.
[CUSTOMER][NEUTRAL] OK, OK
[CUSTOMER][POSITIVE] OK perfect perfect thank you so much [PII] I really do appreciate it.
[AGENT][NEUTRAL] You're welcome and then.
[AGENT][NEUTRAL] Absolutely, [PII], and then one last thing, if you all do file a claim with us once it's been processed by APO we also have a portal in which you should be able to check claim status and have access to our EOB and the website for our portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. So again, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, that'll be all. Only if I can have your last name initial with the reference number for today's call.
[AGENT][NEUTRAL] My name and today's date will be your call reference number and my name again is [PII], first initial to my last name S.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. I hope you have a great rest of your day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I hope you have a great day too, [PII], and thank you again for calling ATL.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.