AccountId: 011433970860
ContactId: d40d8698-7503-4f81-9668-e900491f3886
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193190 ms
Total Talk Time (AGENT): 89726 ms
Total Talk Time (CUSTOMER): 50748 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/d40d8698-7503-4f81-9668-e900491f3886_20250625T17:20_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, um, my name is [PII]. I was calling to get benefits for outpatient.
[AGENT][NEUTRAL] OK, did you say your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] OK, and you're needing only outpatient benefits. You do not need eligibility, is that correct?
[CUSTOMER][NEUTRAL] I need both eligibility and benefits.
[AGENT][NEUTRAL] So, I can help you with both and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] It's 02593075.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And then the information [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK, so I do show that uh she is the spouse of the subscriber on the supplemental policy and the supplemental policy is active. The effective date on it is [PII]. And you said that you were needing outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services per person is $3000.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] With no outpatient deductible.
[AGENT][NEUTRAL] Now because this is a supplemental policy, [PII] to the primary insurance, when the claim is submitted to APL for review, we will also have to have a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have
[CUSTOMER][NEUTRAL] Yeah, that's gonna be for for the claims department, um, and then do you mind telling me if she's used the they already know because we've been taking APO for many years already. Um, do you mind telling me if she's used up any of the $3000 for this year?
[AGENT][POSITIVE] Yes, ma'am. If there is a way you can.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I can check that for you and do you also have our portal website for checking claim status, [PII]?
[CUSTOMER][NEUTRAL] Yes, they have access to that.
[AGENT][NEGATIVE] And as of now, she has not used any benefits for the, for this calendar year.
[CUSTOMER][POSITIVE] OK perfect. Alright, [PII] thank you so much for your help have a good day.
[AGENT][POSITIVE] Thank you. I hope you have a good day too live. That's all I can help you with. Thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye.