AccountId: 011433970860
ContactId: ce02d8d3-e5af-4436-bc3f-152e77d13a45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430959 ms
Total Talk Time (AGENT): 178546 ms
Total Talk Time (CUSTOMER): 150977 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/ce02d8d3-e5af-4436-bc3f-152e77d13a45_20250116T19:33_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, [PII]. My name is [PII] [PII]. I was calling to get outpatient benefits for a patient.
[AGENT][NEUTRAL] OK [PII], you said that you're needing outpatient benefits, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. Just one moment, please, [PII].
[CUSTOMER][POSITIVE] No problem. Mhm.
[AGENT][NEUTRAL] OK, and what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number that you're calling about?
[CUSTOMER][NEUTRAL] It is going to be.
[CUSTOMER][NEUTRAL] One second, let me see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Actually,
[CUSTOMER][POSITIVE] You know what? I'll give you a call back. I don't have the member ID. Thank you, so sorry about that.
[AGENT][NEUTRAL] Yeah. Well, that's OK. I can try and look it up a different way if you would like, [PII].
[CUSTOMER][NEUTRAL] Oh please, thank you. I have um her name and date of birth. I don't know if any of that helps.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I, well, I can't search by date of birth. Um, I can try by the name and it's a, you know, we can just try.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you I appreciate it, um.
[AGENT][NEUTRAL] What is the last name?
[AGENT][NEUTRAL] Or do you have the full social by chance?
[CUSTOMER][NEUTRAL] Last name is
[CUSTOMER][NEUTRAL] Let me see if she's been here before. Let me check if I do have her social by any chance.
[AGENT][NEUTRAL] And is she the subscriber on this plan?
[CUSTOMER][NEUTRAL] I believe she should be the subscriber.
[AGENT][NEUTRAL] OK, so yes, if you have her social, I can try and search that way.
[CUSTOMER][NEUTRAL] Should be on the top
[CUSTOMER][NEUTRAL] She's
[CUSTOMER][NEGATIVE] No social. She didn't give us social and then they pay for it. No, she didn't give us social.
[CUSTOMER][NEUTRAL] I don't think none of her papers maybe.
[CUSTOMER][NEUTRAL] Sometimes they write it, sometimes they don't.
[CUSTOMER][NEUTRAL] Can I give you maybe her last name, maybe?
[AGENT][NEUTRAL] I will, I will have, that will be the only way I can try and search for her. So what is the last name?
[CUSTOMER][NEUTRAL] The last name, she has two last names. It shows here, [PII]. So it's [PII] and [PII]
[CUSTOMER][NEUTRAL] Based [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] [PII]
[CUSTOMER][NEUTRAL] [PII] Yeah, [PII], yeah. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] Uh [PII], which is [PII]
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][POSITIVE] Of course thank you appreciate it.
[AGENT][POSITIVE] Hi, you're welcome.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Yeah, it's not like yeast right.
[CUSTOMER][POSITIVE] I don't give up those things.
[CUSTOMER][NEUTRAL] Sometimes it's on the prescription.
[CUSTOMER][NEUTRAL] Mm, the doctor sometimes right.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I may have located a policy for her, um, and any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is her date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][NEUTRAL] OK, so I did locate a policy for her, uh, and this, she is a subscriber on the supplemental plan. The supplemental plan is active.
[AGENT][NEUTRAL] With an effective date of [PII].
[AGENT][NEUTRAL] The policy number that you should have for this number is 021736-27.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And you needed what type of benefits inpatient, outpatient or office?
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] Um, outpatient, um, such as like her max for the year, what she's used so far.
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII]
[AGENT][NEGATIVE] Cut out completely. I didn't hear any of that.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] What type of benefit information are you needing?
[CUSTOMER][NEUTRAL] It's OK. Um, yeah, so.
[CUSTOMER][NEUTRAL] It's um outpatient benefits like her max for the year and what she's used so far.
[AGENT][NEUTRAL] OK, so her outpatient benefit maximum for covered outpatient services on the supplemental policy is $3000 per covered person per calendar year, and there is no outpatient deductible per covered person per calendar year. When the claim, um, let me see, and you wanna know she's used any for this calendar year, is that correct?
[CUSTOMER][POSITIVE] Yes, please. Yes, thank you.
[AGENT][NEUTRAL] There, no, ma'am. She has not, not as of now.
[CUSTOMER][POSITIVE] Awesome. All right. Um, thank you so much for your help. Yeah.
[AGENT][NEUTRAL] And when
[AGENT][NEUTRAL] You're welcome and just a couple more things, [PII], when the claim is submitted to APL for review, we must also have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim, you should be able to access the EOB for us and the status of the claim by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. OK, awesome. Um, thank you so much again for your help. Thank you for looking that up. It was a big help. Um.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, well, you're very welcome. It was my pleasure. So is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, if I could just have a reference number for the call, please.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Perfect. All right, thank you [PII]. You have a good day.
[AGENT][POSITIVE] Yes, ma'am. You too and thank you again, [PII] for calling APL.
[CUSTOMER][NEUTRAL] Bye bye
[AGENT][NEUTRAL] Bye-bye.