AccountId: 011433970860
ContactId: c452d9ec-7cc7-49e0-a164-1cd96c0943b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212750 ms
Total Talk Time (AGENT): 122198 ms
Total Talk Time (CUSTOMER): 31705 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/c452d9ec-7cc7-49e0-a164-1cd96c0943b8_20250219T21:06_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, I'm calling to see if a patient has benefits coverage for an appointment they're having with us.
[AGENT][NEUTRAL] OK, you're needing to check benefit information on phone number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] It is going to be 01611690.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] And then 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 please and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show she is a subscriber on the supplemental policy, and this supplemental policy is active. The effective date is [PII].
[AGENT][NEUTRAL] And again, what type of benefit information and are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Outpatient, OK. One moment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so she has an outpatient benefit max for covered outpatient services per calendar year of $1500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Has any of the 1000 been used?
[AGENT][POSITIVE] I can check that for you.
[AGENT][NEUTRAL] And again, I may have, it's 1500 for the benefit max.
[CUSTOMER][NEUTRAL] 1500 per calendar year, right?
[AGENT][POSITIVE] Correct, yes ma'am, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for this calendar year as of now, no ma'am, it has not. Now because this is a supplemental policy and to her primary insurance, if you all file a claim with us for her, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which you should be able to check our claim status and have access to our EOB by going to [PII].
[CUSTOMER][NEUTRAL] Alrighty, may I have your name?
[AGENT][NEUTRAL] Again my name is [PII] and you would use my name along with today's date if you need a call reference number.
[CUSTOMER][POSITIVE] Perfect thank you so much for your time I appreciate it.
[AGENT][POSITIVE] You, oh, you're very welcome. So if that's all then that I can help you with, thank you again, [PII], for calling APL and I hope you have a nice evening.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.