AccountId: 011433970860
ContactId: ce8cad31-dd95-439f-adcd-48864203782c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313799 ms
Total Talk Time (AGENT): 132191 ms
Total Talk Time (CUSTOMER): 43440 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/ce8cad31-dd95-439f-adcd-48864203782c_20250509T17:46_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] Hello, my name is uh [PII]. I'm calling to verify eligibility on a patient.
[AGENT][NEUTRAL] OK, you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're just needing eligibility, not benefits, is that right?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] and I'm sorry, what was your name again?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] It's going to be 2, I'm sorry, 02088034.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information that I provide [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just one moment, [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and again, any information provided will be a verification of benefits, not a guarantee of payment. So I do show that she is the spouse of the subscriber on the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And [PII], if you all will be filing a claim with us for her on this policy, we will have to have a copy also of the primary insurance company's explanation of benefits along with the claim for you.
[AGENT][NEUTRAL] And then once we have processed the claim here at APL we do have a portal in which you should be able to check claim status in.
[AGENT][POSITIVE] And the website for that portal is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] And you said this is a supplemental plan?
[AGENT][NEUTRAL] I did. It's a supplement to their primary insurance.
[CUSTOMER][NEUTRAL] All right, perfect. Uh, does this plan have any exclusion pension?
[AGENT][NEUTRAL] I'm so sorry, what was the question?
[CUSTOMER][NEUTRAL] Does the plan have any exclusions?
[AGENT][NEUTRAL] Yes, it would have exclusions on it.
[AGENT][NEUTRAL] Again, this is a supple.
[CUSTOMER][NEUTRAL] Uh, is surgery covered?
[AGENT][NEUTRAL] OK, so you do need benefit information?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And is the surgery to be done at a facility? Is it an outpatient or an inpatient?
[CUSTOMER][NEUTRAL] Um, it's a hos hospital. Uh, should be outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this policy has an outpatient benefit maximum for covered outpatient services per calendar day of $500 and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Alright thank you uh do you have a call reference?
[AGENT][NEUTRAL] You'll use my name along with today's date.
[AGENT][POSITIVE] And again, is there anything else that I can help you? Oh, you're welcome. And if that's all I can help you with, then thank you again for calling APL and I hope you have a great weekend.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Oh, thank you.