AccountId: 011433970860
ContactId: c7fb87b6-07c7-4a96-86fa-fa70a016103c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217580 ms
Total Talk Time (AGENT): 108411 ms
Total Talk Time (CUSTOMER): 39143 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/c7fb87b6-07c7-4a96-86fa-fa70a016103c_20250311T13:25_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] Good morning [PII]. I'm calling from Mount Sinai Medical Center. I'm verifying outpatient coverage.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Do you also need eligibility in addition to benefits or only benefit information?
[CUSTOMER][NEUTRAL] Eligibility and benefits.
[AGENT][POSITIVE] Yes, ma'am, I can help you with both, and who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII] for me. Let me get this over with, OK.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02199739 ML 8.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And I see 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] birth date is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show she is a subscriber on the supplemental policy and it is active. What's an effective date of [PII]?
[AGENT][NEUTRAL] And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] OK, OK, one moment please.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit max per calendar year for covered outpatient services is $2000 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Accumulation
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And as of now she has not used any of her outpatient benefits for this calendar year, Desi.
[AGENT][NEUTRAL] Now when the claim is submitted to APL for review, we will also have to have a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] And then once we have processed our claims there we do have a portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well then thank you very much for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Same to you.
[AGENT][POSITIVE] Yes, ma'am. Thank you very much. Bye bye.
[CUSTOMER][NEUTRAL] OK bye bye.
[CUSTOMER][NEUTRAL] Bye.