AccountId: 011433970860
ContactId: c2bd8f8b-0155-4aa3-8cc0-a265f9fd72af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 194509 ms
Total Talk Time (AGENT): 97900 ms
Total Talk Time (CUSTOMER): 37943 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/c2bd8f8b-0155-4aa3-8cc0-a265f9fd72af_20250530T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling to verify coverage for a patient.
[AGENT][NEUTRAL] OK, are you needing eligibility and benefits or one or the other?
[CUSTOMER][POSITIVE] Just benefits.
[AGENT][POSITIVE] Yes, ma'am, I can help you with just benefits and who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Is 016.
[CUSTOMER][NEUTRAL] 78152 ML8
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you 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], your date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I do show he is the spouse of the subscriber on the supplemental policy and what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So on this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $5000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], because this is a supplemental policy to the primary insurance when the claim is submitted to APO for review, 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 at APL, we do have a portal that you should be able to check claim status in and our website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and um has the, has any claims or has anything been used towards that 5000?
[AGENT][NEGATIVE] As of now, no, ma'am, for no benefits have been used for this calendar year.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] Well, you're very welcome. And is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Nope, that is it. Have a great day.
[AGENT][POSITIVE] OK, well, I hope you have a great day too, [PII], and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye.