AccountId: 011433970860
ContactId: cf2e3c15-b342-4fd2-b2e9-2a64416851ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274730 ms
Total Talk Time (AGENT): 130847 ms
Total Talk Time (CUSTOMER): 77351 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/cf2e3c15-b342-4fd2-b2e9-2a64416851ef_20250417T13:50_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm from provider's office. I'm here to check patient eligibility and benefits.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And could you spell your first name for me please?
[CUSTOMER][NEUTRAL] First name, [PII].
[AGENT][NEUTRAL] OK, ma'am. Thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the patient's policy number, please?
[CUSTOMER][NEUTRAL] Patient policy number, I do have 1452819 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information man that I did provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] First name as [PII], last name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And spell the first name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, so I do show that he is a dependent on the supplemental policy. The supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Outpatient, uh, I need the professional benefits for outpatient surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh, how much.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services for covered person is $1500 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy man to the primary insurance, we will also have to receive a copy of the primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL we do have a portal in which you should be able to check claim status and our website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Thank you for the information. So does the patient has no responsibility to work the supply policy right now, right?
[AGENT][POSITIVE] Yes, sir, you're welcome.
[AGENT][NEUTRAL] I'm sorry, I didn't understand your question.
[CUSTOMER][NEUTRAL] Patient has no responsibility right now for the supplement plan, right?
[AGENT][NEUTRAL] That would be up to the provider. I can only provide you what the outpatient benefit maximum is on the policy. I can't guarantee payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for the confirmation. Can you spell your name?
[AGENT][NEUTRAL] You're welcome. [PII] to last name [PII], and my name in today's date would be your call reference number.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you. Thank you for assisting. Have a good day. Bye-bye.
[AGENT][POSITIVE] OK, you're welcome. Yes, [PII], you too. If that's all I can help you with, thank you again for calling APL.