AccountId: 011433970860
ContactId: e4913b6e-bd50-43ab-a963-53d024f5d13a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286980 ms
Total Talk Time (AGENT): 146282 ms
Total Talk Time (CUSTOMER): 43253 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/e4913b6e-bd50-43ab-a963-53d024f5d13a_20250217T15:06_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] Hi, [PII], this is [PII] calling from South Miami Hospital. I need to get eligibility and benefit for a patient.
[AGENT][NEUTRAL] OK. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, initial of my last name is [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, [PII], thank you, and you're needing eligibility and benefits for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things and what is your callback number please [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Um, 1979903.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And now by 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 their date of birth?
[CUSTOMER][NEUTRAL] Oh, this is [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that he is a subscriber on the supplemental policy, and now with this supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] This is gonna be outpatient. This is a 48 hour observation.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] It's taking a moment to load my information, [PII].
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so he has an outpatient benefit maximum of $500 per covered person per occurrence for covered outpatient services, and there is no outpatient deductible per cover person per occurrence.
[CUSTOMER][NEUTRAL] OK, pre-certification is not required, no.
[AGENT][NEUTRAL] That is correct. Now, because this is a supplemental policy, when the claim is submitted to APL, we must also receive a copy of his primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL, then we do have a portal in which you should be able to check claim status by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again to check claim status and also have a copy of our EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um can I have the first initial of your last name?
[AGENT][NEUTRAL] Sure, the first initial is [PII] and my name along with today's date will be your call reference number.
[CUSTOMER][NEUTRAL] OK, and where should we send the claim?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] You are certainly very welcome and is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] That's about it thank you.
[AGENT][POSITIVE] OK, well then thank you for calling APO and I hope that you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Yes ma'am thank you bye bye.