AccountId: 011433970860
ContactId: d4b1ec8c-a1ec-4173-b33b-cdb69705ba66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254460 ms
Total Talk Time (AGENT): 123900 ms
Total Talk Time (CUSTOMER): 67164 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/d4b1ec8c-a1ec-4173-b33b-cdb69705ba66_20250507T18:22_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, I need eligibility and benefits on a patient.
[AGENT][NEUTRAL] OK, you have one patient that you need the eligibility and benefit information for, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] YAM is that correct?
[CUSTOMER][NEUTRAL] yeah, [PII]
[AGENT][POSITIVE] I'm sorry, you know, spell that one more time. I was doing so well, try to.
[CUSTOMER][NEUTRAL] Yeah. [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] YS OK, thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number.
[CUSTOMER][NEUTRAL] It is 0249746M.
[AGENT][NEGATIVE] OK, we're missing a number. You said 0249746 and then M. That's not a valid number. Yes, that's not a valid number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02497462.
[CUSTOMER][NEUTRAL] you said.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There
[AGENT][NEUTRAL] And any information provided will be a verification of benefits you know and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So I do show that she is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And you know what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Outpatient um diagnostic testing.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so for this supplemental policy, the outpatient benefit maximum per calendar year for covered outpatient services is $2500 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And as of now, no benefits have been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, because this is a supplement, mhm, you're gonna use my name that I gave you along with today's date, and because it is a supplemental policy, we will have to have a copy of the primary insurance company's explanation of benefits with the claim for review.
[CUSTOMER][NEUTRAL] Um, is there a reference to that?
[AGENT][NEUTRAL] And then once our claim has been processed here we do have our portal that you should be able to check claim status in.
[AGENT][NEUTRAL] And the website for that portal is secured. [PII].
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, I'm sorry, what was your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] All right. Well, you're certainly very welcome. So is there anything else, [PII], that I can help you with today?
[CUSTOMER][POSITIVE] No, that was it. Thank you.
[AGENT][POSITIVE] Well, you're welcome and thank you for calling APL. I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.