AccountId: 011433970860
ContactId: c5c9cf17-8d59-4bed-8ba6-d4277f47d3c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254399 ms
Total Talk Time (AGENT): 118874 ms
Total Talk Time (CUSTOMER): 65442 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/c5c9cf17-8d59-4bed-8ba6-d4277f47d3c0_20250207T21:38_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] Um, hi, good day. This is [PII] from provider's office. I'm just calling to check for benefits and eligibility for the patient I have here.
[AGENT][NEUTRAL] OK. And you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK, [PII], so you're needing benefits and eligibility for a member, is that correct?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Um, for my callback number, it's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Um, policy number is 2483111.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information [PII] that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it's for, um, it's a ES Portis, um, date of birth of [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I do show that she is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And [PII], what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the outpatient
[CUSTOMER][NEUTRAL] Um, does this cover, um, office visit?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am, office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And uh may I know what is the maximum benefit for the patient?
[AGENT][NEUTRAL] One moment. So for covered outpatient services, the benefit maximum is $9100.
[AGENT][NEUTRAL] Her calendar year for covered outpatient services with no deductibles.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And also, um, do you have any reference number for this patient?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date and just a couple of additional things, [PII]. If a claim is submitted to APL for review, we must also receive a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal that you can check claim status in and have access to our explanation of benefits and that portal website for us is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, Secure [PII].
[AGENT][POSITIVE] Secured.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. OK, got it. And also, um, can you spell your name for me? Sorry.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] And last name initial?
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][POSITIVE] Um, it's [PII] as well. And I guess um I got all information. Thanks again for your help. You have a great weekend. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] For you, yes ma'am, you're certainly very welcome, and if that is all I can help with, thank you again ma'am for calling APL.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, bye-bye.