AccountId: 011433970860
ContactId: c7561df3-0b8f-4cf9-9065-2faeb899e77d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252490 ms
Total Talk Time (AGENT): 136658 ms
Total Talk Time (CUSTOMER): 47918 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/c7561df3-0b8f-4cf9-9065-2faeb899e77d_20250624T16:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, this is [PII]. I'm calling from the University of Miami. I'm just trying to verify the benefits of a subscriber.
[AGENT][NEUTRAL] OK, [PII], you don't need eligibility, you only need benefits. Is that correct?
[CUSTOMER][POSITIVE] Uh, yes, correct.
[AGENT][POSITIVE] OK, yes, I can help you with benefits. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] It is 01611795 ML8.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so yes, she is covered as a dependent on this policy, on the supplemental plan, and what type of benefit information do you need for her micro inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so in this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $1500 for covered insured.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And as of now, and this is for [PII], correct?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] I'm so sorry. Let me try that one more time. OK. So as of now, she has not used, I was looking at, there's a lot of several people on this policy, I should say. As of now, she has not used any of her benefits for this calendar year.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, so deductible, not use any of their deductible, uh, how about out of pocket?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, now this is the supplemental policy, [PII]. This is a supplemental policy, not the major medical insurance. So the benefit maximum on this plan per calendar year is 1500 with no outpatient deductible.
[CUSTOMER][NEGATIVE] Nothing, so it's, oh sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when the claim is submitted to APL 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 reviewed and processed our claim.
[AGENT][NEUTRAL] We do have a portal that you should be able to check claim status in and that website is located at [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] My last question is, uh, there's no co-pay or co-insurance?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not on the supplemental plan. Correct.
[CUSTOMER][NEUTRAL] Because of that?
[CUSTOMER][POSITIVE] Got it, got it.
[CUSTOMER][POSITIVE] Uh, OK, thank you.
[AGENT][POSITIVE] OK. Well, you're very welcome. So, can I help you with anything else?
[CUSTOMER][NEUTRAL] Uh, nope, that's all.
[AGENT][POSITIVE] OK, well then thank you again for calling APO and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye.