AccountId: 011433970860
ContactId: e0ee46af-e148-43b4-b710-26a90f6e42f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254619 ms
Total Talk Time (AGENT): 93092 ms
Total Talk Time (CUSTOMER): 130377 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/e0ee46af-e148-43b4-b710-26a90f6e42f3_20250324T18:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. Uh, my name is [PII] and I'm calling from a from a provider's office. I wanted to verify the benefits for patients.
[AGENT][POSITIVE] OK, well, I can definitely help you with the um benefits and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] It is APL 02185191 M as in Mary, L as in Lima number 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so for this particular policy number, I'm showing it's no longer active as of [PII], but there is also an active policy. Um, hold on, let me get that number for you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, OK, so it changed on [PII], the number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] Cause that's the card I had with that number.
[CUSTOMER][POSITIVE] OK, I'm ready for the new number.
[AGENT][NEUTRAL] So it's um [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And this has been effective since [PII] [PII].
[CUSTOMER][NEUTRAL] OK, OK, so it's a shorter number now 233-7128. Is there a group number or no group number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, I believe it's the same. Hold on one second. Yes, the group number is 23293.
[CUSTOMER][NEUTRAL] OK, so it is the same number, OK.
[CUSTOMER][POSITIVE] OK perfect thank you for that.
[AGENT][NEUTRAL] You're welcome. And then what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, so the patient's looking to have surgery, um, mm, outpatient surgery. I just wanted to see, um, the policy with the maximum coverages because I know with her primary insurance, um, she has, um, $3500 deductible and I believe it's like a 6800, um, out of pocket, so I did want to verify how much her coverage, um, was, uh, with APL to see if she had any difference she would incur, um, after you guys cover the amount.
[AGENT][NEUTRAL] Mhm. OK, so for the calendar year max for outpatient is $1000. Um, did you want me to see if any has been used for this year?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so she has a $1000.
[AGENT][NEUTRAL] Mhm calendar year maximum for outpay.
[CUSTOMER][NEUTRAL] What's um the coverage?
[AGENT][NEUTRAL] It's a $1000 calendar year maximum for her outpatient benefits.
[CUSTOMER][NEUTRAL] OK, calendar year. OK, um, yes, can you check for me if um any of it has already been used?
[AGENT][NEUTRAL] Mhm. Hold on one moment. OK, so none of the benefits for [PII] have been used yet.
[CUSTOMER][NEUTRAL] None of them, OK, so she only, um, OK, so she has $1000 coverage that's all she has for outpatient, um, surgery.
[AGENT][NEUTRAL] Right, we pay towards the co-pay, the deductible and co-insurance of covered charges after primary.
[CUSTOMER][POSITIVE] OK, OK, perfect. OK, let me let her know then because I, I think she probably thought she would be covered a little more, but, uh, let me then, um, explain that to her that she's only covered for $1000 calendar year. OK, thank you so much for that, [PII].
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, that was everything.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL. I hope you have a great week.
[CUSTOMER][NEUTRAL] You too bye bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.