AccountId: 011433970860
ContactId: d7375919-b678-45df-a157-f067b3927e9f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257329 ms
Total Talk Time (AGENT): 126249 ms
Total Talk Time (CUSTOMER): 78406 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/d7375919-b678-45df-a157-f067b3927e9f_20250109T13:09_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I need, um, eligibility and benefits on a gap policy.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Will you spell your name for me, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] Thank you. And your, what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 01678898M08.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show, OK, so I'm so sorry. I got ahead of myself, you know, any information that I provide for you today 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] I
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] Thank you. So I do show that she is the subscriber on the supplemental policy and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK, so her outpatient benefit max per calendar year for covered outpatient.
[AGENT][NEUTRAL] Services.
[AGENT][NEUTRAL] Is $1000.
[AGENT][NEUTRAL] And there is no outpatient deductible.
[CUSTOMER][NEUTRAL] OK. Does she have any benefits remaining?
[AGENT][NEUTRAL] Are you referring to this calendar year?
[CUSTOMER][NEUTRAL] Yeah, has she used it.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] to
[AGENT][NEGATIVE] As of now, there have, she has not used any benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when the claim is submitted to APL for review, you know we will have to have a copy of a primary insurance company's explanation of benefits as well. And then do you already have our portal or claim status and our EOVs can be accessed.
[CUSTOMER][NEUTRAL] Um, I am not sure. I mean, in there, can you check the eligibility and the benefits as well, or just for claims?
[AGENT][NEUTRAL] No, ma'am. You cannot, no, ma'am. You will have to, yes, ma'am. Uh-huh. But that website is secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is there a reference number to the call?
[AGENT][POSITIVE] Yes, ma'am, you would actually use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] I'm sorry, what was your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. OK, thank you so much.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome. And is there anything else on the list that I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you again for calling [PII]. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.