AccountId: 011433970860
ContactId: df233773-06a0-4735-9b50-093c35194c2d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228460 ms
Total Talk Time (AGENT): 98881 ms
Total Talk Time (CUSTOMER): 42605 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/df233773-06a0-4735-9b50-093c35194c2d_20250507T18:58_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to get benefits on a patient.
[AGENT][NEUTRAL] OK, [PII], you're needing benefit information only you do not need eligibility, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Ma'am, I can help you with that, and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] Thank you and the member's policy number.
[CUSTOMER][NEUTRAL] Mm, give me just a second.
[CUSTOMER][NEUTRAL] 02595727 ML8
[AGENT][NEUTRAL] OK, say that one more time for me.
[CUSTOMER][NEUTRAL] 02595727 ML 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Office
[AGENT][NEUTRAL] OK, is this for an office visit or treatment for an office visit?
[CUSTOMER][NEUTRAL] It's for
[CUSTOMER][NEUTRAL] An X-ray done in an office.
[AGENT][NEUTRAL] OK, so her outpatient benefit maximum per calendar year for covered outpatient services is $1000.
[CUSTOMER][NEUTRAL] Setting
[AGENT][NEUTRAL] And there is no outpatient deductible per cover person per calendar year.
[AGENT][NEUTRAL] Because this is a supplemental policy to her primary insurance when the claim is submitted to APL for review, we will also have to receive a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed the claim here at APL [PII], we do have a portal in which claim status should be able to be checked and the website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] OK, out of the 1000 that you guys cover per year, has anything been used?
[AGENT][POSITIVE] I can check that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] As of now, no ma'am, there have not been any benefits used for this calendar year.
[CUSTOMER][NEUTRAL] Can I have a reference number for the call?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect thank you have a great day.
[AGENT][NEUTRAL] All right. Well, you too, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] That is it. Thank you.
[AGENT][POSITIVE] OK, well you're welcome and thank you again for calling APL. I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.