AccountId: 011433970860
ContactId: df0a4b2b-870e-4016-b69b-0c4249622cd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290519 ms
Total Talk Time (AGENT): 141761 ms
Total Talk Time (CUSTOMER): 67064 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/df0a4b2b-870e-4016-b69b-0c4249622cd8_20250110T13:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I'm calling to verify your patient's benefits.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify benefits only or do you also need eligibility information?
[CUSTOMER][NEUTRAL] I also need eligibility. Thank you.
[AGENT][POSITIVE] Yes, ma'am. I can help you with both of those things, [PII]. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]. There is no extension.
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 022 03921, M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK, thank you, [PII]. Give me just a couple of moments to get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information, [PII] 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] [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of information are you needing, [PII] inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this on this supplemental policy, [PII], the outpatient benefit max.
[AGENT][NEUTRAL] Is $6000 per calendar year per covered person for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because this is a supplemental policy to their primary insurance, we will also have to have a copy of his primary insurance company's explanation of benefits along with the claim. And then you may already have this, but we have a portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In which our claim status can be checked with access to the EOBs for APL by going to secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is it AM corporate?
[AGENT][NEUTRAL] No, ma'am. Am public.
[AGENT][NEUTRAL] [PII] U [PII] L I [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, do you need to register?
[AGENT][NEUTRAL] You will, you will just follow the steps through, um, and again,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a self-register.
[CUSTOMER][NEUTRAL] OK, OK, sounds good. Um, is there any accumulation? What is the, uh, full amount, um, available, the $6000?
[AGENT][NEUTRAL] Are you calling for a service in [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] As of now,
[AGENT][NEGATIVE] I do not see that any benefits have been used for this calendar year.
[CUSTOMER][NEUTRAL] OK, sounds good thank you. And um [PII], can I have the first initial of your last name?
[AGENT][NEUTRAL] Sure. It is [PII], and my name along with today's date will be your call reference number.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Well, you're very welcome, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That was it. Thank you. Have a good day.
[AGENT][POSITIVE] Well, yeah, absolutely. I hope you have a nice day and a nice weekend as well, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] OK.