AccountId: 011433970860
ContactId: bda4a8ef-a24c-4514-90dd-2f7a002d36f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257358 ms
Total Talk Time (AGENT): 147621 ms
Total Talk Time (CUSTOMER): 62562 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/bda4a8ef-a24c-4514-90dd-2f7a002d36f8_20250502T19:23_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] with Baptist Health [PII], and I was calling to verify eligibility and benefits for a member.
[AGENT][NEUTRAL] I think.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits for someone, for one of our members?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Direct line is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 02449742
[AGENT][NEUTRAL] OK, thank you one moment while I get that information pulled up.
[CUSTOMER][NEUTRAL] Thank you. And do you spell your name with [PII] [PII]?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I.
[CUSTOMER][POSITIVE] With an [PII] Thank you.
[AGENT][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] And my last initial is [PII] if you need it.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Any information that I do provide for you today, [PII] 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] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on the supplemental policy and it is active, effective [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this policy, the supplemental policy, outpatient benefit maximum per calendar year for covered outpatient services is $2000.
[AGENT][NEUTRAL] And there is no outpatient deductible for covered person per calendar year.
[AGENT][NEUTRAL] Because this is a supplement [PII] to his primary insurance when the claim is submitted to APO for review, we will also have to have a copy of his primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which you should be able to check claim status.
[AGENT][POSITIVE] And that website is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And [PII], I do show we're a supplement mhm. No ma'am, I was just gonna say it does appear that he has used all of his outpatient benefits for this calendar year.
[CUSTOMER][NEUTRAL] And you are just a you're.
[CUSTOMER][POSITIVE] Oh, go ahead, I'm sorry dear.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Back
[AGENT][NEUTRAL] Mm, exhaustion.
[CUSTOMER][NEUTRAL] So you all are a supplemental medical policy, correct?
[AGENT][NEUTRAL] Or a supplement to his primary insurance. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, well, I know, um, I don't know if you were just like set up a medical or if it was like a gap plan.
[AGENT][NEUTRAL] No, it's a supplemental they can't have this without having major medical coverage through their employer.
[AGENT][NEUTRAL] And it helps them with co-pays, deductibles, and co-insurance amounts up to their maximum benefit, and it does appear that he has met his calendar year max already for this calendar year.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Awesome. Well, I do thank you [PII]. Is there a call reference?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much, sweetie. You have a great day and a good weekend.
[AGENT][POSITIVE] Well, thank you so much. I hope you do too. Is there anything else that I could help you with?
[CUSTOMER][NEUTRAL] That's it, dear.
[AGENT][NEUTRAL] OK, [PII]. Well, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] You