AccountId: 011433970860
ContactId: dc8f0d91-309b-4039-9819-227ebdcda307
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248580 ms
Total Talk Time (AGENT): 136086 ms
Total Talk Time (CUSTOMER): 78054 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/dc8f0d91-309b-4039-9819-227ebdcda307_20250226T13:26_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. This is [PII] calling from DTC at Jackson Memorial. I need to uh verify eligibility for a member service.
[AGENT][NEUTRAL] OK, [PII], do you need eligibility only or do you also need benefit information as well?
[CUSTOMER][NEUTRAL] Um, this is a supplemental plan, correct?
[AGENT][NEUTRAL] I would have to, we offer different kinds of policies, [PII], so until I get the member's information pulled up, I I won't be able to answer that question for you.
[CUSTOMER][NEUTRAL] OK, so I just need benefits.
[AGENT][NEUTRAL] OK, so you do need eligibility and benefit information, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] It is 02583150 ML8.
[AGENT][NEUTRAL] OK, thank you. So give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Um first name is [PII], and last name is uh [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that he 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 do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the outpatient benefit max per calendar year per covered person for covered outpatient services is $7900 and there is no outpatient deductible for covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, I just need to verify that the patient had active benefits because he has a primary plan, so this would be second.
[AGENT][POSITIVE] That is great.
[AGENT][POSITIVE] That is correct. And when this.
[CUSTOMER][NEUTRAL] All right, and you said your name was?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII], and [PII], if you all will be filing a claim with us for this patient, we will also have to have a copy of his primary insurance company's explanation of benefits along with the claim for review.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal that you can check our claim status and have access to our EOB by going to secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I've been calling you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII], is that spelled [PII]?
[AGENT][NEUTRAL] Yes ma'am, [PII] and you would use my name along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] And the initial to your last name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Have a great day.
[AGENT][POSITIVE] Well, yes, ma'am, [PII], you too, if that's all I can help you with. Thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.