AccountId: 011433970860
ContactId: cce4bf0a-e7dc-4c58-8afc-1118858fcdd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300720 ms
Total Talk Time (AGENT): 156899 ms
Total Talk Time (CUSTOMER): 66985 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/cce4bf0a-e7dc-4c58-8afc-1118858fcdd0_20250221T20:03_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, good afternoon. I needed to get benefits for a patient, please.
[AGENT][NEUTRAL] OK. Do you, you only need benefits or do you also need eligibility?
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] Um, also, yeah, also eligibility.
[AGENT][NEUTRAL] OK, you need both? Uh yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] 842-074 NL 8.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, like, any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So he had been the subscriber on this policy, but this policy number you gave me is no longer active. This policy was active from [PII].
[AGENT][NEUTRAL] The current active policy that he has with us has a different number.
[AGENT][NEUTRAL] And that active policy 02295851.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that policy is active with an effective date of [PII]. And just a moment for me to get that information pulled up, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what type of benefit information and again on the name you said it was [PII] and what what did you say the last name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. We do not have it double.
[AGENT][NEUTRAL] In our system, his name is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Yeah, it, it's just one new.
[CUSTOMER][MIXED] They wrote it wrong here, but yeah, it's just one [PII].
[AGENT][NEUTRAL] OK, alright, and again, what type of benefit information do you need on the supplemental policy inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] It's for outpatient diagnostic studies.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the outpatient benefit maximum per calendar year for covered outpatient services is $3500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, and then does he still have benefits remaining on that 3000?
[AGENT][NEUTRAL] And this is for this calendar year that no, it was 3500.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, is there anything, have you used any of that or is that still remaining?
[AGENT][NEGATIVE] As of now, no, ma'am, he has not used any benefits as of now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because this is a supplemental policy related to his primary insurance, when the claim is submitted to APL you will also need to send us a copy of his primary insurance's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We do have a portal that you can check claim status in and have access to our explanation of benefits and that website for that is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] That was all but do you give reference numbers for your phone calls?
[AGENT][POSITIVE] Yes, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right then that's everything thank you so much.
[AGENT][POSITIVE] Well, you're certainly very welcome. And thank you again for calling ATL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.