AccountId: 011433970860
ContactId: d316f8dd-4fe7-46cb-bf9d-282e66448fa4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 207729 ms
Total Talk Time (AGENT): 114676 ms
Total Talk Time (CUSTOMER): 53729 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/d316f8dd-4fe7-46cb-bf9d-282e66448fa4_20250226T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, good morning, [PII]. My name is [PII], and I am calling from the diagnostic Center of Miami. I need to get benefits on a patient, please.
[AGENT][NEUTRAL] OK, [PII], do you also need eligibility or only benefit information?
[CUSTOMER][NEUTRAL] Yes, I need the eligibility as well, mhm, yes.
[AGENT][NEUTRAL] Both
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] I have 02359542 ML 8.
[AGENT][NEUTRAL] Thank you one moment while I get the information pulled up please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information that I do provide for you, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I can show that she is the spouse of the subscriber on the supplemental policy, and this supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, for outpatient, outpatient MRI or advanced radiology? Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on the supplemental policy, the outpatient benefit maximum per calendar year per covered person for covered outpatient services is $1500 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] Because this is
[CUSTOMER][NEUTRAL] You said it's 1500? I'm I'm sorry to interrupt you. You said 1500, correct?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh. No, that's OK.
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] And because of it being a supplemental policy to the primary insurance when the claim is submitted to APL, we must also have receive a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have reviewed our claim, we do have a portal, Giovanna that you all should be able to check claim status for us and have access to our EOB by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, thank you so much for your assistance. I really appreciate it.
[AGENT][NEUTRAL] And it
[AGENT][POSITIVE] You, you are certainly very welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you. Have a wonderful day.
[AGENT][POSITIVE] OK. Yes, ma'am. I hope you do too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh, bye-bye.