AccountId: 011433970860
ContactId: d177143b-4a6e-427d-8107-c87347b0796e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240259 ms
Total Talk Time (AGENT): 119913 ms
Total Talk Time (CUSTOMER): 77580 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/d177143b-4a6e-427d-8107-c87347b0796e_20250306T18:46_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] Yes, hi, good afternoon. Uh, yes, I'm calling from Baptist Hospital of Miami. I need to verify this insurance if it's active.
[AGENT][NEUTRAL] OK, you're just needing to verify if the policy is active or not, is that correct?
[CUSTOMER][POSITIVE] Yeah, uh-huh, and the benefits, yes.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] You also need, so you need eligibility and benefit information?
[CUSTOMER][POSITIVE] Yes, yes, both, yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah mhm.
[AGENT][NEUTRAL] Thank you. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 02337124.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments for you to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And like any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. [PII]. [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show she is the spouse of the subscriber on the supplemental policy. The supplemental policy is active with an effective date of [PII]. And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hospital outpatient services.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So on the supplemental policy, the outpatient benefit max per calendar year for covered outpatient services per person is $1000 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And when the claim is submitted to APL for review [PII], we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Is there any accumulation so far?
[AGENT][POSITIVE] OK, I can check that for you.
[CUSTOMER][POSITIVE] I appreciate it thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And as of now, no, ma'am, there is not.
[CUSTOMER][NEUTRAL] Uh, sorry?
[AGENT][NEUTRAL] As of now, there is no accumulation on file for her for this calendar year.
[CUSTOMER][NEUTRAL] Oh, OK. All right. OK, thank you. Can I have your name or a reference number for this phone call, please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Again, my name is [PII], and you would use my name along with today's date [PII] as your call reference number and then also do you already have our website for our portal to the claim status for us can be checked in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If not
[CUSTOMER][NEUTRAL] Uh, no, that will be for another department. That's fine, thank you. What's the initial of your last name?
[AGENT][NEUTRAL] OK, well,
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And is there anything else?
[CUSTOMER][NEUTRAL] Let me ask you, now that you mention a portal, yeah, now that there is a portal instead of me calling to verify eligibility and benefits is an APL portal for that?
[AGENT][NEUTRAL] The portal, the portal is for checking claim status and having access to the EOB for us once we have reviewed our claims. The website is [PII].
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK.
[CUSTOMER][POSITIVE] I see. OK. All right. Thank you very much. Have a nice day. Bye-bye.
[AGENT][POSITIVE] OK. Well, you're very welcome. Yes, ma'am. You too. Thank you for calling AP.