AccountId: 011433970860
ContactId: bf22609a-6cc4-4dbf-bfc8-b6b566f1f765
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249910 ms
Total Talk Time (AGENT): 121410 ms
Total Talk Time (CUSTOMER): 46998 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=2.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/bf22609a-6cc4-4dbf-bfc8-b6b566f1f765_20250604T13:00_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. My name is [PII] calling from Memorial Regional Hospital. I was just calling to check on eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, you're needing to check eligibility and benefits for a member, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the member's policy number?
[CUSTOMER][NEUTRAL] It's 0234, I'm sorry, 02304177 ML 8.
[AGENT][NEUTRAL] OK, [PII], thank you. Give me a moment to get the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][POSITIVE] Thank you. It's going to be [PII] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that he is the subscriber on the supplemental policy and it is active [PII] with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit? Actually, give me one second to look at one thing on here.
[AGENT][NEUTRAL] OK, and what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $2000 and there is no outpatient deductible per cover person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy to his primary insurance, when the claim is submitted to APO we will have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed the claim here, [PII], we have a portal that you should be able to check his claim status in by going to [PII].
[AGENT][NEGATIVE] And as of now there have not been any benefits used for this calendar year.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] Well, you're welcome. Is there anything else that I could help you with this morning?
[CUSTOMER][NEUTRAL] Um, can I also just get a reference number, please?
[AGENT][POSITIVE] Yes ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, thank you. And I'm sorry, you said your last name initial is [PII]?
[AGENT][NEUTRAL] [PII]. My first name is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][POSITIVE] OK. Well, you're very welcome and thank you again for calling APL if that's all I can help you with, I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You do the same.
[AGENT][POSITIVE] Yes, ma'am. Thank you very much.
[CUSTOMER][NEUTRAL] OK. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.