AccountId: 011433970860
ContactId: bfa2a0c0-3b21-49eb-b2dd-05598d586781
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349839 ms
Total Talk Time (AGENT): 178197 ms
Total Talk Time (CUSTOMER): 79863 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/bfa2a0c0-3b21-49eb-b2dd-05598d586781_20250328T12:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good morning [PII].
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] This is [PII]. I'm calling from.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Baptist Hospital in [PII] regarding a patient that we have in common.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. [PII], and what type of information are you needing today? Eligibility, benefits, claim status?
[CUSTOMER][NEUTRAL] I'm just needing to verify the benefits.
[AGENT][NEUTRAL] OK, you're needing benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The policy number for the patient?
[CUSTOMER][NEUTRAL] Yes ma'am, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Would that be the cert number?
[AGENT][NEUTRAL] Yes ma'am, uh-huh.
[CUSTOMER][NEUTRAL] I guess
[CUSTOMER][NEUTRAL] Uh, it's 1471.
[CUSTOMER][NEUTRAL] 163.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] OK, and then the information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, she had been dependent on this policy, but this policy is no longer active.
[AGENT][NEUTRAL] This policy was active from [PII].
[AGENT][NEUTRAL] And there is another policy that is active under a different number, [PII].
[AGENT][NEUTRAL] And that policy number.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, let me get you that information.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Give me just a moment on that one please.
[AGENT][NEUTRAL] OK, so the current policy that is active is going to be policy number 01.
[AGENT][NEUTRAL] 975906.
[AGENT][NEUTRAL] And this policy is active as of [PII].
[AGENT][NEUTRAL] And she is also covered under this policy and what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, it's outpatient. Can I just confirm the policy number? I have 01975906.
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK, uh, she's outpatient, she's currently having an MRI.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar day for covered outpatient services is $500 with no outpatient deductible.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And because this is a supplemental policy, [PII] to the primary insurance, we will also have to have a a copy of the primary insurance EOB along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a website in which you should be able to check claim status.
[AGENT][NEUTRAL] And our website for that actually is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So she has $500 and she hasn't used that.
[AGENT][NEUTRAL] And is there any information or anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, can I have the first initial of your last name?
[AGENT][NEUTRAL] Sure, it is [PII], and my name along with today's date would be your call reference number.
[CUSTOMER][NEUTRAL] And I'm sorry, just to confirm you did say she hasn't used the 500.
[AGENT][NEUTRAL] No, that's not what I said. I said that she has an outpatient benefit max.
[CUSTOMER][NEUTRAL] Oh, what you
[AGENT][NEUTRAL] Per calendar day for covered outpatient services of $500 with no outpatient deductible.
[AGENT][NEUTRAL] This is a per calendar day benefit, not a per calendar year.
[CUSTOMER][NEUTRAL] OK, so for her visit today she would be allowed the 500.
[AGENT][NEUTRAL] As of now, we have no claims for today's data service. I can't guarantee payment. I can only provide the benefits, so.
[CUSTOMER][NEGATIVE] Oh no, no.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Well, you're very welcome. And again, is there anything else I