AccountId: 011433970860
ContactId: c48d3db1-664d-45d4-b8f7-f72e09a3641e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360529 ms
Total Talk Time (AGENT): 150911 ms
Total Talk Time (CUSTOMER): 110682 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/c48d3db1-664d-45d4-b8f7-f72e09a3641e_20250203T21:28_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], good afternoon. How are you?
[AGENT][POSITIVE] I'm good, and yourself?
[CUSTOMER][POSITIVE] Doing good, thank you. I'm calling you from an urgent care on behalf of South Miami Hospital um to check the eligibility and benefits of the patient.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefit information on a member for urgent care?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with those things. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] I'm gonna tell you right now it is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the member's policy number please?
[CUSTOMER][POSITIVE] I'm gonna tell you right now, give me one quick second if you can. Thank you.
[AGENT][NEUTRAL] Sure. Uh-huh.
[CUSTOMER][NEUTRAL] All righty. hello?
[AGENT][NEUTRAL] Yes, I'm here. Mhm.
[CUSTOMER][NEUTRAL] Hi, OK, sorry, thank you. So I had the patient show me because they don't have the, the physical card they have it like virtually so I'm looking at the card right now, but I don't see anywhere where it shows the member ID all they see is like the group number, effective date, the plan, and it says in hospitals benefit certification number and outpatient benefit certification number. Is it that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so [PII], yes, yes. Either one of those, actually the policy number is the first part of either one of those numbers. If you'll notice they're identical prior to the ML.
[CUSTOMER][NEUTRAL] Yeah, correct. OK, so let me give you that. I have 02565726 M as in Mary, L as in Larry, and then 7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] You have on the brain.
[CUSTOMER][NEUTRAL] I can tell you
[CUSTOMER][NEUTRAL] And if you need the patient's uh name and ID, I mean name and date of birth, I have that. OK, thank you.
[AGENT][NEUTRAL] In just one moment. Yes, in just one moment.
[AGENT][NEUTRAL] OK, so any information, [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. So he is the subscriber on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And he had on this supplemental policy, he has an outpatient benefit maximum.
[AGENT][NEUTRAL] Of $750 per calendar day for covered outpatient services with no outpatient deductible.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Because this is a supplemental policy, [PII], to his primary, when you all file the claim with us, we will also have to have a copy of his primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Yes, ma'am. He also has a primary insurance through Ames, so.
[AGENT][NEUTRAL] Correct. So we'll have to have that EOB along with the claim for us to review. And then we do have our portal. Are you already familiar with our portal where you can check claim status?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I go to secure.
[CUSTOMER][NEUTRAL] No, we normally, we normally call for that. We don't have any access to the portal.
[AGENT][NEUTRAL] OK, so it's a self-registering portal. It's a self-registering, so I can give you that website, but it's secured.
[CUSTOMER][NEUTRAL] Well, at least I don't.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, but let me ask you a quick question. So now since this supplemental one is active, it covers his copay, right? That's what he told me.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] This is something that we will review. I again, I can't guarantee payments, but I can provide you, yes. He has $750 per calendar, his benefit amount per calendar day for covered outpatient services is $750 with no outpatient deductible.
[CUSTOMER][NEUTRAL] OK, OK, understood, understood.
[CUSTOMER][NEUTRAL] OK, perfect. And can I get your name please and your last initial?
[AGENT][NEUTRAL] Again, my name is [PII]. The first initial to my last name is [PII] and my name and today's date would be your call reference number.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All righty, [PII], thank you so much for your help then. I appreciate it.
[AGENT][POSITIVE] Well, you are certainly very welcome. So if that's all then, [PII], that I can help you with, thank you again for calling APO and I hope that you have a nice evening.
[CUSTOMER][POSITIVE] You as well thank you bye bye.
[AGENT][POSITIVE] Uh-huh, and thank you too. Bye-bye.