AccountId: 011433970860
ContactId: d3b654b8-6a71-4433-8be1-8df96422a8f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244300 ms
Total Talk Time (AGENT): 112851 ms
Total Talk Time (CUSTOMER): 86359 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/d3b654b8-6a71-4433-8be1-8df96422a8f8_20250227T20:11_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, this is [PII] calling from the provider's office for checking on an eligibility and benefit status for the patient.
[AGENT][NEUTRAL] OK. Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're needing eligibility and benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]. It's your direct line?
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Uh, the member ID is uh
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] 02331550. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, the patient's full name is [PII]. [PII] is the patient's date of birth.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hi [PII], she is the spouse of the subscriber on this supplemental policy, and the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit information are you needing inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, this is for the deductible amount, ma'am, only. And uh, can you help me with the network, please?
[AGENT][NEUTRAL] Again, are you needing inpatient, outpatient, or office benefits?
[CUSTOMER][NEUTRAL] Oh, ma'am, it's for the outpatient. Before that, can you please help me with a group number of this patient?
[AGENT][NEUTRAL] The group number is 19232.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So the outpatient benefit maximum.
[AGENT][NEUTRAL] Per cover person per calendar day for covered outpatient services is $350 with no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Uh, ma'am, thank you so much for this information. And is the claims mailing address [PII] Ok [PII]. This is correct, ma'am?
[AGENT][NEUTRAL] That is correct. Mhm. That is correct. And because, and yes, ma'am, and one a couple of additional things, [PII], because this is a supplement to her primary insurance, when the claim is submitted to APL for review, you must also send us a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] Thank you so much, ma'am.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you can check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Sure, ma'am. Thank you so much for this information as well. And uh can you please uh help me with the call reference number for your call, ma'am?
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Thank you so much for this information, ma'am. Thank you again for assisting me today. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Yes, [PII], you too, and thank you for calling APL. Have a nice evening.