AccountId: 011433970860
ContactId: c0a6b575-6c26-4fd8-a6f3-bbb6284da4f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265290 ms
Total Talk Time (AGENT): 105199 ms
Total Talk Time (CUSTOMER): 46367 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/c0a6b575-6c26-4fd8-a6f3-bbb6284da4f6_20250414T18:54_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm just calling to confirm this patient's coverage for an upcoming surgery they have at the hospital.
[AGENT][NEUTRAL] OK, are you needing to verify eligibility or eligibility and benefits?
[CUSTOMER][NEUTRAL] Uh, just eligibility and and benefits.
[AGENT][NEUTRAL] Both? OK. I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] I have 02493395, Mike Lima 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[AGENT][POSITIVE] Thank you any information that I do provide for you.
[AGENT][NEUTRAL] Today would be a verification of benefits and not a guarantee. It's your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][POSITIVE] Thank you. So I do show that she is a subscriber on the supplemental policy.
[AGENT][NEUTRAL] And it is active with an effective date of [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, outpatient hospital.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit maximum of $500 per calendar year for covered outpatient services, and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] 500 outpatients, uh, per calendar year. How much of those do you have remaining?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and as of now she has not used any of her calendar year benefits.
[CUSTOMER][POSITIVE] OK, so she has a full amount remaining perfect.
[AGENT][NEUTRAL] Yes sir and then a couple of additional pieces of information for you, [PII] when the claim is submitted to APL for review, we will also have to have a
[AGENT][NEUTRAL] Copy of her primary insurance company's explaned benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal that you should be able to check claim status for us.
[AGENT][NEUTRAL] By going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it. OK, alright.
[AGENT][NEUTRAL] All right, well, and is there anything else I can help you with?
[CUSTOMER][POSITIVE] That's everything for now. Thank you so much.
[AGENT][POSITIVE] Well you're very welcome and thank you.
[AGENT][POSITIVE] For calling APL. I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thank you you as well bye bye.
[AGENT][POSITIVE] Uh, thank you. Bye-bye.