AccountId: 011433970860
ContactId: db4752cd-5c08-427b-bb60-48ff1d512831
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193830 ms
Total Talk Time (AGENT): 107167 ms
Total Talk Time (CUSTOMER): 50860 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/db4752cd-5c08-427b-bb60-48ff1d512831_20250424T12:15_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is. How may I help you today?
[CUSTOMER][NEUTRAL] Good morning calling for benefits and eligibility please.
[AGENT][POSITIVE] I'll be glad to help you. Go and give me your name and the member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah my name is [PII].
[CUSTOMER][NEUTRAL] Members's policy number is.
[CUSTOMER][NEUTRAL] Hang on.
[CUSTOMER][NEUTRAL] It is my policy number.
[CUSTOMER][NEUTRAL] 01659400 ML 8.
[AGENT][NEUTRAL] Alrighty, thank you for that information, [PII]. Now while I'm pulling this up, go ahead and give me a good return telephone call number please, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright [PII], thank you for all that information. Now, your patient's name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. Looks like [PII] is the insured on this medical supplemental plan. They show the original effective date as [PII]. patient is current and active, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] Yes, um, this is our secondary insurance?
[AGENT][NEUTRAL] This is a supplemental plan. Mhm.
[CUSTOMER][NEUTRAL] I'm not
[CUSTOMER][NEUTRAL] OK, all right, OK.
[CUSTOMER][NEUTRAL] And what are the benefits, please?
[AGENT][NEUTRAL] OK, what type of benefits are you looking for today?
[CUSTOMER][NEUTRAL] She's having surgery in an ambulatory freestanding facility.
[AGENT][NEUTRAL] Alrighty, let me get that pulled up. OK, now, of course, what we are [PII] is her medical supplemental plan. So the only thing that we would pick up and pay on is anything for sickness and injury that is applied towards her deductible, co-pay, or co-insurance at her primary insurance carrier. Now her outpatient benefit here is no deductible, no pre-cert, and her max payable per calendar year is $7900.
[CUSTOMER][NEUTRAL] OK, does she still have the full $7900?
[AGENT][NEUTRAL] Let's see what she's made.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Looks like right now she's made $7800 of that max as of today.
[CUSTOMER][NEUTRAL] Oh, so she only have $100 available.
[AGENT][NEUTRAL] As of today, yes, ma'am.
[CUSTOMER][NEUTRAL] All right, may I please have the reference number for the call?
[AGENT][NEUTRAL] Well, we don't give reference numbers, [PII], but you can use my name on today's date and my name is [PII] spelled [PII]
[AGENT][NEUTRAL] Is that all I can help you with?
[CUSTOMER][POSITIVE] OK, [PII], great.
[CUSTOMER][POSITIVE] Yes, yes, thank you so much.
[AGENT][POSITIVE] Yes, ma'am, [PII], thanks for calling APO. You have a great day.
[CUSTOMER][NEUTRAL] Too bye bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.